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February 12, 1938

DIAGNOSIS OF HEART DISEASE IN CHILDRENREGRESSION OF PHYSICAL SIGNS

JAMA. 1938;110(7):501-506. doi:10.1001/jama.1938.02790070025007
Abstract

The diagnosis of the presence or absence of heart disease is of importance to both the pediatrician and the child. Difficulties in differential diagnosis are encountered frequently enough to warrant a consideration of accepted criteria of diagnosis.

In recent years the clinical significance of a systolic murmur has been unduly minimized. It is frequently stated that about 50 per cent of average normal children present a systolic murmur on routine physical examination.1 In marked contrast is the reported incidence of organic heart disease, ranging between 1 and 2 per cent. It is obvious that a large group of children, on routine physical examination, present a diagnostic problem.

The criteria essential for a diagnosis of organic heart disease are stated to be (1) characteristic constant physical signs and (2) enlargement of the heart.2 The reliability of these criteria in determining the presence of organic heart disease, as well as

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