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April 4, 1977


JAMA. 1977;237(14):1434-1435. doi:10.1001/jama.1977.03270410034009

In Reply.—  We thank Dr Kumar for his comments, particularly those emphasizing the importance of noninvasive techniques in the evaluation of the postinfarction patient. We did not, as Dr Kumar states, review the role of apexcardiography in our succinct section on noninvasive techniques; nevertheless, we featured Dr Golin's classic work1 comparing sensitivity and specificity of palpation, ECG, x-ray, and apexcardiogram in both the introduction and clinical clues sections.Dr Kumar has thoughtfully emphasized the two separate roles of apexcardiography, viz, estimation of the left ventricular end-diastolic pressure and the semidiagnostic systolic and diastolic bulges (present, it should be emphasized, only when the capsule is properly placed over the previously palpated abnormal bulge).2 Unfortunately, most aneurysm series are rather small and, not infrequently, are retrospective. Dr Kumar found diagnostic abnormalities in 62% of his 35 patients. Both Mills et al3 and Dubnow4 found ECG evidence consistent with