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The chief hope of influencing favorably the mortality and morbidity of coronary heart disease rests with the earliest possible detection of its presence in an individual, as well as the elimination of predisposing factors. The only means available at present by which the presence of coronary disease can be detected before symptoms are present is by the electrocardiogram. Although one is not justified in attempting to diagnose heart disease from an electrocardiographic tracing alone, changes in the coronary circulation frequently occur which can be detected by electrocardiogram long before symptoms or signs become apparent. The extent to which disease must progress before symptoms become evident varies with individuals and is by no means constant. An exact relationship between the objective appearances in the electrocardiogram and the symptoms and progression of the disease has not been established.
A serial study of electrocardiograms in conjunction with the physical examination and an analysis
JOHNSON HJ. A STUDY OF 2,400 ELECTROCARDIOGRAMS OF APPARENTLY HEALTHY MALES. JAMA. 1940;114(7):561–563. doi:10.1001/jama.1940.02810070027007