The thesis of our communication concerned the too-frequent dismissal by physicians of "minor" changes in chest roentgenograms and ECGs without using the prognostic information that may be discerned. For example, no comment was made in the focal manuscript1 on electrocardiographic changes of left atrial abnormality. While they may be termed "minor" by some, repeated studies have underscored their importance in hypertensive heart disease. Other changes were also termed "minor" (eg, aortic widening and pulmonary fibrosis). This information is not of minor importance, especially if not already known. Indeed, we submit that if any individual who consistently had previously normal ECGs and chest roentgenograms were told that he had left atrial abnormalities, nonspecific ST-segment and T-wave changes, early left ventricular hypertrophy, or old or new pulmonary lesions, he would be concerned; this information also would be appreciated by the treating physician.
Dr Klinefelter questions how these minor changes or