1920 Journal of the American Medical Association  
Diagnosis.-This case was diagnosed "double mitral dis¬ ease," that is, mitral stenosis, because of the symptoms, the pounding heart action, and the suspicion of a presystolic murmur. The whole picture is that of nervousness with the effort syndrome. COMMENT The differential diagnosis in young people between heart disease and nervousness, or the so-called "effort syndrome," is in need of great emphasis at the present time. This is particularly true in the case of young women, who are probably
more » ... who are probably more susceptible in civil life to the condition than are young men. A woman, aged 30, admitted to St. Luke's Hospital in December, 1916, had had a severe abdominal pain about four hours before admission, and had fainted. On admission, she was in shock, and was bathed in cold perspiration; the pulse was almost imperceptible, but could be counted at the apex with the stethoscope, the heart rate being 152 a minute. The abdomen showed a b[ill]ardlikerigidity. There was a mass in the left fornix, and as the patient had skipped her last menstrual period a diagnosis of ruptured ectopic
doi:10.1001/jama.1920.02620090012005 fatcat:o5vbu42imbf5pkx2ny4bjkmhmm