It is true that physical examination has limitations. The assessment of severity of valvular lesions by this method is not always accurate. Early cardiomyopathy is difficult to recognize. Diagnosis of pericardial effusion has never been strength of physical examination. All these are best recognized and assessed by echocardiography.
Cardiac auscultation is a skill acquired over years of training.
Cost factor is very important for a developing country like ours. Auscultation also provides a source of information of independent clinical value and this can be illustrated by a few examples. Cardiac catheterization studies may not provide clear differentiation between pericardial constriction and myocardial restrictive disease. Presence of an ejection click or opening sound, usually indicates proper functioning of the prosthetic valve and loss these sounds warm the impending or actual malfunctioning of these devices and warrant use of imaging techniques. However, prolapse is often diagnosed from echocardiogram in the absence of any auscultatory findings, causing over diagnosis with its attendant psychological and insurance problems.