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April 1948


Arch Intern Med (Chic). 1948;81(4):518-533. doi:10.1001/archinte.1948.00220220089006

IN PREVIOUS reports1 it has been pointed out that the true significance of the relationship of apical systolic murmur to underlying cardiac disease has not received due recognition. The consequences of failure to evaluate properly apical systolic murmur was brought to my attention during the late war, and it is to emphasize the result of underestimating this sign that additional material is presented. While serving with the navy, I saw in consultation large numbers of naval personnel in whom the sole objective symptom was a loud systolic murmur at the apex. In none of the cases was there enlargement of the heart; diastolic murmurs were not heard, electrocardiograms were not abnormal and signs of heart failure were not present. Yet the men and women concerned had been on the sick list for days, weeks or months. To the National Naval Medical Center at Bethesda, Md., which in the first

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