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To the Editor:—
There has been an exchange of correspondence regarding an asymptomatic 18-year-old boy presumably with aortic insufficiency, possibly on the basis of rheumatic fever, with a normal electrocardiogram and roentgenogram. He is or was on an athletic scholarship for basketball or track. My advice was: "From the information at hand, the only safe advice is to avoid competitive sports."Dr. Lurie has answered this by saying that "an apparently safe, conservative course of action by the physician can do harm." He sensibly emphasizes the avoidance of iatrogenic heart disease.Dr. Lurie is not as impressed as I with the diastolic murmur and the fact that, if this heart disease is on the basis of rheumatic fever, at age 18 there is almost certainly residual rheumatic activity. These are the people who can dilate their ventricles and pass the point where prosthetic valves can be placed. Strenuous competitive sports
Harken DE. Heart Disease and Sports-Reply. JAMA. 1962;181(4):354. doi:10.1001/jama.1962.03050300074029