The Unheard Diastolic Murmur in Acute Rheumatic Fever

Abstract

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 . . .