To the Editor:
The history and physical examination of the patient with ischemic cardiomyopathy that was presented in the May 2 Clinical Crossroads column (*) fell short.
First, reporting patterns of “chest pain” in a patient with ischemic heart disease invites errors in history taking because ischemic chest discomfort is often not painful, but “squeezing,” “heavy,” etc.
Second, reporting jugular venous pressure on the basis of venous distention is crude and, unless the patient’s posture is provided, useless.
Third, reporting that a patient’s “pulses were intact,” leaving the arteries anonymous and the pulse-amplitude unspecified, communicates little.
Finally, a typographical error describing the patient’s “normal S1 and S1” [sic] reinforces the inattention given to the case description.
All professions have their slang and verbal short-cuts, but these temptations to substitute reflex for reflection should be resisted.
(*) Zimetbaum PJ. A 59-year-old man considering implantation of a cardiac defibrillator. JAMA. 2007; 297: 1909-1916.