The war has altered opinion of the value of many signs formerly accepted as important indications of the presence of organic heart disease. The chief sign involved in the changed point of view is the systolic murmur. The significance attached to diastolic murmurs, both the diastolic murmur of aortic insufficiency and the presystolic murmur (auriculo-systolic) of mitral stenosis, has remained unaltered. Persons affected with these two diseases have been found not to bear the strain of war satisfactorily, even if at the time of enlistment they were free of any indication of heart failure. They are now, accordingly, rejected for service.
The significance of systolic murmurs, especially their relation to mitral insufficiency, however, has occasioned much discussion. Systolic murmurs occur in so large a number of persons that it has become necessary to decide when they are important and denote mitral insufficiency. The need for making the distinction between important
COHN AE. THE EFFORT SYNDROME: TOGETHER WITH A CONSIDERATION OF THE SIGNIFICANCE OF CERTAIN MURMURS. JAMA. 1918;71(26):2132–2137. doi:https://doi.org/10.1001/jama.1918.26020520001010
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