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November 13, 1943


JAMA. 1943;123(11):693. doi:10.1001/jama.1943.82840460001007

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During the summer of 1942 while examining a man with a rapid heart, I asked him to lean forward the better to appreciate the auscultatory findings. He responded by bending to a 90 degree angle, when the rate abruptly slowed, apparently because of vagus influence. This was to me something new and was confirmed and since then has been verified in many tachycardias. This slowing occurred in most cases but not all and amounted to about one third of the previous rapid rate and required a full 90 degree angle, for in some cases a bending to something less did not produce slowing. The most pronounced effect came in the first ten to twenty seconds, when a gradual quickening ensued.

Many clinicians have wished to examine a rapid heart when slower and have relied on recumbence to secure this end. A forced expiration after a deep inspiration to slow the

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