Document 6B00kGjvadr1JrzZBn0JvD816

132 INDUSTRIAL HYGIENE AND OCCUPATIONAL MEDICINE normal limits. There was no evidence of decompensation. The patient also had chronic glomerulonephritis in a latent stage. Test.--Before exercise, the pulse rate was 64; immediately after exercise, 78; one minute after exercise, 64; two minutes after exercise, 64. Case 2.--The patient was a 29 year old white man, a brewer, who had had acute rheumatic fever at the age of 20 years. He was of stocky build, being 66 in. (167.5 cm.) tall and weighing 200 lb. (90.5 Kg.). On examination he was found to have a diastolic murmur at the base of the heart and presystolic and systolic murmurs at the mitral area, with an accentuated first sound. A distinct capillary pulsation was present. A roentgenogram showed a definitely enlarged, boot-shaped heart (fig. 3). An electrocardiogram was definitely abnormal, with Fig. 3 (case 2).--Teleoroentgenogram of a patient with aortic insufficiency, mitral stenosis and mitral insufficiency. The response to the exercise tolerance test was normal. Fig. 4 (case 4).--Electrocardiogram of a patient with clinical signs of mitral stenosis. A wide notched P wave is present in leads II and III. The response to the exercise tolerance test was normal. changes considered compatible with combined myocardial strain. The diagnosis was compensated rheumatic heart disease with aortic insufficiency, mitral stenosis and mitral insufficiency. Test.--Before exercise the pulse rate was 96; immediately after exercise, 138; one minute after exercise, 96; two minutes after exercise, 96. Case 3.--A 40 year old white man had a blood pressure of 158/90 and a history suggestive of angina. An electrocardiogram was definitely abnormal with prolonged intraventricular con duction time and abnormal STT segments in leads II and III (fig. 2 A). Test.--Before exercise the pulse rate was'90; immediately after exercise, 120; one minute after exercise, 90; two minutes after exercise, 90. Case 4.--The patient was a 35 year old white man, a bookkeeper, for whom the diagnosis of mitral stenosis had first been made two years previously. The size and the shape of the heart I i-v