At the beginning of the 20th century, the 3 leading causes of death in the United States were infectious diseases—pneumonia, tuberculosis, and diarrhea—which in combination claimed 539 lives per 100 000.1 Lurking in the background as the fourth leading cause of death was heart disease (137 deaths per 100 000). But this would change. With life expectancy of only 47 years at the beginning of the century, people did not live long enough for heart disease to claim many lives. Without a means for accurate diagnosis, many deaths from heart disease went unrecognized. With the advent of the electrocardiogram to facilitate the diagnosis of heart disease, antibiotics to treat infectious diseases, and increasing life expectancy, the number and proportion of deaths due to heart disease soared. During the Great Depression, the number of deaths due to heart disease was twice that of the next leading cause of death (pneumonia). In 1945, at the time of President Roosevelt's fatal brain hemorrhage due to decades of uncontrolled hypertension, heart disease accounted for more deaths in the United States than the next 3 causes combined. Deaths due to heart disease peaked in 1968 at 374 per 100 000.
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The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
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