In a recent article, Surawicz1 makes a tongue-in-cheek comment on Proctor Harvey's analogy of the hand, quoted in Hurst and Logue's textbook.2 In this analogy, Harvey likened the diagnostic approaches to heart disease to the five fingers of a hand, the thumb representing history; the index finger, physical examination; the middle finger, the ECG; the ring finger, the chest x-ray film; and the little finger, all other diagnostic techniques. Commenting on this analogy, Surawicz observes that the emergence of echocardiography upset the balance in the hierarchy of the digits: "The addition of the echocardiogram to the little finger... would most certainly have resulted in the hyperplasia of this finger." In fact, he points out, the echocardiogram can successfully compete for diagnostic value with the ECG and the x-ray film.
Not only does echocardiography compete with electrocardiography and roentgenography in diagnosing a host of cardiac and pericardial structural abnormalities,