Year: 1946
Type: article
Abstract: EARLY DIAGNOSIS OF VALVULAR DISEASE 9 per cent of 30,000 rejections for all causes ; of this 9 per cent, four-fifths were for rheumatic heart disease (Parkinson, 1945).In the United States, Rowntree (1945) estimated that 6 per cent of 2,976,000 total rejections were for cardiovascular reasons.About half were due to rheumatic lesions (Levy, Stroud, and White, 1943).Wilburne and Ceccolini (1944) examined 20,000 men and found that 6 per cent of all rejections were for cardiovascular lesions and that 63 per cent of these were rheumatic.Perrot (1944) found that 8 per cent of all rejections were for cardiovascular reasons.METHOD OF EXAMINATION Past History.No great reliance was placed upon a past history of rheumatic fever or chorea, whether negative or positive; too many men, in their eagerness to serve or to escape service, will falsify such a history; the same applies to a story of dyspnaea on exertion.Inspection.This served to exclude obvious aneemia or goitre, and to note nutrition, physique, and any deformity of the chest or spine.Palpation.The apex beat was then found by placing the whole hand lightly upon the chest wall under the left breast.It was noted whether the impulse was displaced or too forcible.Minor degrees of scoliosis frequently move the apex beat outwards.The anterior chest wall was then palpated for the presence of a thrill, the palm of the hand being laid lightly over the apex and then over the base of the heart.A thrill at the base of the heart may best be felt by the observer standing on the right of the subject who leans forward and stops breathing at the end of full expiration; the hand should be merely applied to the chest wall, not pressed hard.No reliance whatever was placed upon a doubtful thrill at any site.Auscultation.The heart sounds were then considered, whether normal or abnormal, their loudness, and any variations in character which frequently lead to doubt in diagnosis.A split first sound which is fairly common in health sometimes led to an unjustified suspicion that early mitral stenosis was present; an accompanying double quality in the feel of the apex beat added to this suspicion.The first sound may otherwise vary in loudness or clarity in' different subjects without significance.It is often said that a pulmonary second sound, loud or duplicated or both, is a sign of early mitral disease.But this is not so-such variations are common in healthy young adults.The normal third heart sound, so common in the young (Thayer, 1909 ; Evans, 1942b), was also frequently mistaken for a mitral diastolic murmur.Bramwell (1943) found a reduplication of the second sound at the apex, which he considers to be identical with the third heart sound, to be frequently mistaken for mitral 0 0 -o
Source: Heart
DOI: 10.1136/hrt.8.4.212
Authors: J. Parkinson, R. Hartley
Institution: Royal London Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2079448278