Some Pitfalls in the Diagnosis of Heart Disease

Abstract

DESPITE tremendous advances in available knowledge about heart disease, many puzzling problems cannot be resolved, as yet, by the newer laboratory tests or apparatus. Their evaluation and solution still depend in large measure upon the clinical experience and judgment of the attending physician. This paper is an attempt to show some of the problems that doctors meet in diagnosing a seemingly simple situation. The reader knows, of course, that there are many types of heart conditions. These vary according to the cause-arteriosclerosis, hypertension, rheumatic fever, hyperthyroidism, syphilis, and others-as well as the character of the lesion-valvular disease, pericardial disease, and disease of the heart muscle itself, to mention a few. In addition to this, the doctor may be confronted with changes in rhythm of the heart beatauricular fibrillation; auricular tachycardia, ventricular tachycardia, and so on-which may, or may not, be associated with problems of making a diagnosis. Sometimes, inadequate facilities or unusual circumstances may make errors of diagnosis unavoidable. From a practical standpoint, an incomplete diagnosis, even though undesirable, often may not significantly influence the treatment of the patient. Situations may occur, however, where such errors or obscurity of the diagnosis could lead to unwise therapy or unnecessary hardshiptfor the patient.