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The Unheard Diastolic Murmur in Acute Rheumatic Fever

1959; Massachusetts Medical Society; Volume: 260; Issue: 26 Linguagem: Inglês

10.1056/nejm195906252602608

1533-4406

Alvan R. Feinstein, Rodolfo Di Massa,

Diverse Musicological Studies

A CRUCIAL feature in the clinical diagnosis of rheumatic heart disease is the demonstration of certain characteristic cardiac murmurs that presumably indicate valvular deformity.1 These murmurs can exist with or without a positive history or associated abnormalities in the patient's physical examination, laboratory and other data.2 For this reason, the major diagnostic procedure in rheumatic heart disease is auscultation. Despite advances in acoustic and electronic technics, the auscultatory instrument in most general use is a combination of the ears, stethoscope and mind of the physician. The frequency and consequences of occasional imperfect function of this instrument are considered below.Methods . . .