Medicine: Heart Murmurs

Many people whose doctors tell them that they have something the matter with their hearts have nothing of the sort. That is the conclusion of three Manhattan physicians, headed by Dr. Leonard J. Goldwater, after a ten-year study of hundreds of "heart cases" sent to them by the New York State Employment Service, which wanted to find out what kind of work was suitable for its "handicapped" clients.

The three doctors worked in a special clinic set up at Bellevue Hospital. They took their time—unlike many of the doctors who had diagnosed the patients originally. Among 631 cases, 175 (or 28%) were found to have no heart disease at all. (All but 19 had been told that they had; the 19 had misdiagnosed themselves.) The biggest group of wrong diagnoses (38) had been made by draft doctors at induction centers, but private and school physicians, hospital clinics, insurance examiners and industrial physicians all contributed to the total of bad guesses.

How did the doctors come to err so often? Their commonest stumble was a "functional" (i.e., not organic) heart murmur, of a type which Dr. Goldwater describes as "transitory, innocent." Sometimes they were misled by high blood pressure. Other errors were more surprising: tuberculosis, cancer of the stomach and latent syphilis were all mistaken for heart trouble.

In 56 cases, doctors had advised the patients to take it easy; in some instances they had gone so far as to recommend quitting a job or turning down a new one. But the perversity of human nature is evident in the Goldwater report: only 19 of the 56 took the doctor's advice, while seven who had not been told to cut down their activities did so anyway.

"When non-cardiac patients are advised to limit their activities, as a result of incorrect diagnosis, the result is calamitous," say Dr. Goldwater and his colleagues. "Not only needless disability has been created, but irreparable psychic trauma also is often produced . . . Large numbers of young men are again being examined in connection with military service. It seems particularly timely to point out again that what is designed to serve as a preventive measure may prove to be just the opposite."