Key elements of Cardiological Examination include observation, palpation and, most importantly, hearing (impact is omitted). As in all other areas of physical examination, determining proper exposure and tranquility in the environment is critical. Initially, the patient should remain in the supine position with the upper body raised by 30 to 45 degrees. Most exam tables have an adjustable top. If not, use 2 or 3 pillows. Remember that although heart rate and blood pressure are discussed in the vital signs section, they are actually important elements of a heart test.