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Normal Electrocardiographic Variants Simulating Ischemic Heart Disease

Henry J. L. Marriott, MD
JAMA. 1967;199(5):325. doi:10.1001/jama.1967.03120050067014.
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The partnership of an electrocardiograph and an unskilled, or perhaps overconfident, interpreter can be a threat to life and limb. The most serious harm is done when the clinical context of a normal variant is disregarded and, with overreliance on the tracing itself, coronary or myocardial disease is pronounced.1 This may turn a normal person into a cardiac-disease cripple. At least one instance of suicide resulting from the effects of misinterpretation has been reported,2 and I have personally encountered the following socioeconomic consequences: unnecessary hospitalization with resulting serious financial embarrassment, cardiac-disease neurosis, denial of needed life insurance, postponement of marriage.3 Such miscarriages of diagnostic justice can cause serious and lasting dislocations in our patients' lives, and so it is clearly the duty of everyone who presumes to interpret electrocardiograms to know the limitations of electrocardiography—or rather, we must fully appreciate our own limitations as interpreters. What is


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