Nathan Flaxman, M.D.
JAMA. 1934;103(18):1395. doi:10.1001/jama.1934.02750440055024.
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To the Editor:—  In the case report by Dr. Wilmot F. Pierce on coarctation of the aorta in The Journal, September 15, there is the statement on page 831 at the top, "The heart rhythm was absolutely irregular." It was my impression that such a statement has become obsolete except when modified by something more definite, as suggesting sinus arrhythmia, auricular fibrillation or extrasystoles. More than 80 per cent of irregular heart rhythms may be diagnosed definitely without the use of the electrocardiogram. The second sentence following the one quoted gives the electrocardiogram reading, which states that "there was left axis deviation, simple tachycardia, and left ventricle and right ventricle extrasystoles." This seems to indicate that one must have an electrocardiogram to know whether an irregular cardiac rhythm is or is not due to ventricular extrasystoles. Too often this appears to be the case, that is, let the electrocardiogram make


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