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To the Editor:—
The Journal (178:1056 [Dec. 9] 1961) carried a reply in reference to a 42-year-old woman complaining of pains in the left shoulder. She apparently has 8 attacks daily, each lasting 10 minutes. No relation to effort is mentioned. "Nitroglycerin (but not pentaerythritol) gives relief." What's more, she has a diaphragmatic hernia. Your consultant claims that this is evidence for coronary sclerosis and advises apparently permanent anticoagulation.I shall not go into the matter of the preventive value of anticoagulants in coronary sclerosis; this is, to say the least, controversial. But I strongly suspect that in the absence of definitive ECG changes during an attack, or at least after exercise, the diagnosis should be open to question. I hardly believe that the level of cholesterol has more than a statistical value from a diagnostic viewpoint. Thus, to expose the woman—on such a dubious basis—to the psychologic trauma
Salomon MI. Coronary Sclerosis and Hiatus Hernia. JAMA. 1962;179(10):824. doi:10.1001/jama.1962.03050100078022
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