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J. K. LEWIS, M.D.

Arch Intern Med. 1934;53(5):741-761.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

King¹ and King and McEachern² described a group of physical signs by means of which they were able to recognize bundle branch block in 85 per cent of patients with this condition. These signs consist of a visible or palpable double apical impulse, reduplication of the first sound at the apex, an asynchronous first sound and murmur and asynchronous systolic murmurs. The abnormal impulse was found in over 80 per cent of their patients and was regarded as the most important sign. A reduplicated first sound was present in 56 per cent of their patients, and the other signs mentioned occurred less frequently. In a number of patients they obtained graphic evidence of the presence of a double systolic apical impulse by photographing the movements of a straw or its shadow attached to the chest wall at the site where the abnormal impulse was seen or felt.

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Author Affiliations
SAN FRANCISCO

From the Department of Medicine, Stanford University School of Medicine.

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