Modification of chest physiotherapy interventions is recommended for patients with concomitant respiratory and cardiac diseases. What modifications are necessary and for whom, and what strategies physiotherapists adopt when heart disease is present, have not been investigated. Consequently, few guidelines exist. A questionnaire survey was conducted to identify attitudes and practices of senior cardiopulmonary physiotherapists (SCPP) and "other" physiotherapists (OP) regarding modified and head-down postural drainage (HDPD) when heart disease is present. The overall response rate was 44% (178/407); the response rate from SCPP (78%, 50/64) was higher than from OP (37%, 128/343). Major findings included that: postural modification in the presence of heart disease is common and is not reserved for patients with severe disease; the most commonly adopted modified position is the horizontal; and that the rationale for modification is commonly based on the assumptions that the cardiovascular load is less and, thus, adverse outcomes will be avoided. In the main, the response patterns for both groups were similar, but some between-group differences were found. The findings overall suggest physiotherapists adopt a cautious approach to HDPD when heart disease is present. Whether this approach is justified remains to be investigated.