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Presentation of Case A 41-year-old woman was transferred to this hospital because of thrombocytopenia, anemia, and changed mental status. There was a history of treated hypothyroidism, well-controlled hypertension, and mild anemia of several years' duration accompanied by slight leukopenia. Hematologic studies were performed seven months before admission (Table 1). A test for antinuclear antibodies, performed 11 months before admission, was negative. The patient was otherwise well until five days before admission, when she was admitted to another hospital because of one week of substernal pain that radiated to the left hand, tingling in the right leg, intermittent headaches, and light . . .

Presentation of Case A 25-year-old man was admitted to the hospital because of the recent onset of congestive heart failure and atrial fibrillation. The patient had been well until four months earlier, when he had a severe upper respiratory tract infection, which resolved with one week of bed rest at home. Two months before admission he was admitted to another hospital because of polydipsia, polyuria, polyphagia, and a weight loss of 9 kg. The blood glucose concentration was as high as 437 mg per deciliter (24.3 mmol per liter). Radiographic study of the chest and an ultrasonographic examination of the . . .

Presentation of Case A 57-year-old woman was admitted to the hospital because of dyspnea, chest pain, and a mass in the right atrium and ventricle. The patient had been well until three days earlier, when she experienced the onset of dyspnea, which persisted. That night she was awakened by severe right-sided pleuritic chest pain. On the following day the pain recurred, and she coughed up gross blood; she was admitted to another hospital. The hematologic laboratory values are presented in Table 1. The lactate dehydrogenase level was 1119 U per liter (normal, 313 to 618). The values for urea nitrogen, creatinine, . . .

Presentation of Case A 31-year-old man was admitted to the hospital because of severe mitral regurgitation with congestive failure. He was well until the age of 16 years, when dyspnea and a cough developed, with a bout of syncope. A diagnosis of constrictive pericarditis was made, and a pericardiectomy was performed; a tuberculin skin test was reported to be negative. Thereafter the patient felt well until three years before entry, when he began to experience brief bouts of atrial fibrillation and was told that he had a murmur. Two years before admission a prolonged episode of atrial fibrillation was accompanied . . .

Presentation of Case A 28-year-old man was admitted to the hospital because of recurrent ventricular tachycardia. There was a 12-year history of chronic active hepatitis with cirrhosis for which the patient took prednisone daily. Nine years before entry ulcerative colitis developed, with frequent exacerbations, especially during the spring. Four years later eosinophilia was detected; it ranged from 10 to 20 percent on differential counts and decreased during intervals when increased doses of prednisone were given. Anosmia and alopecia universalis developed, with apparent improvement when doses of prednisone were higher. Fifty-eight months before entry third-degree atrioventricular block occurred, and a subcutaneous . . .

Myocarditis occasionally masquerades as acute myocardial infarction because patients may present with severe chest pain, electrocardiographic changes, and elevated serum levels of creatine kinase. In patients with normal coronary arteries who presumably died of acute myocardial infarction, myocarditis has been reported as an incidental abnormality at autopsy1–4. Although there have been anecdotal clinical reports of myocarditis mimicking myocardial infarction in patients with normal coronary arteries, this association has almost always relied on a demonstration of diffuse electrocardiographic abnormalities or a preceding viral illness in young patients with few coronary risk factors5–7. In most cases no definitive . . .

Presentation of Case A 69-year-old man was admitted to the hospital because of severe epigastric pain. There was a history of coronary artery disease with an inferoposterior myocardial infarct 20 years earlier and four admissions to another hospital because of unstable angina pectoris during the ensuing 9 years. Angina persisted, and a coronary angiographic examination, performed elsewhere 9 1/2 years before entry, showed complete occlusion of the right coronary artery and high-grade obstruction of three other vessels. Seven years before admission an exercise-tolerance test was strongly positive. Six and a half years before entry the patient was seen at this . . .

Presentation of Case A nine-year-old girl was admitted to the hospital because of congenital heart disease. She was born of the fifth pregnancy of a mother aged 33 years. At two months of gestation rupture of the spleen occurred after minor abdominal trauma, and the mother underwent splenectomy under spinal anesthesia at another hospital. A postoperative wound infection was treated with unknown antibiotics over an interval of several weeks. Vaginal delivery of a breech presentation was induced two weeks early. There was a transient decrease in the fetal heart rate during delivery, but the child cried spontaneously and appeared active . . .

Presentation of Case A 50-year-old man was admitted to the hospital because of biventricular failure. A heart murmur was discovered at the age of six years, and he became intolerant of exercise in ...

Presentation of Case A 17-year-old boy was admitted to the hospital because of a heart murmur. He was born the sixth of nine children, of a normal delivery. His early growth and development were no...

Presentation of Case First admission. A 35-year-old man was admitted to the hospital because of cyanotic congenital heart disease. He was born of an uncomplicated pregnancy; no abnormality was dete...

Presentation of Case A 28-year-old man was admitted to the hospital because of hypertension. He was well until seven years previously, when mild hypertension was found; no treatment was prescribed....

PERCUTANEOUS transluminal angioplasty is frequently used in selected patients to decrease stenoses in atherosclerotic peripheral arteries,1 , 2 renal arteries,3 4 5 6 and coronary arteries.7 8 9 Th...

Presentation of Case A 49-year-old man was admitted to the hospital after collapse at work. He was reportedly well until three weeks earlier, when he fell and sustained a laceration of the right leg. A physician noted that his blood pressure was 150/90 mm Hg but prescribed no antihypertensive medication. During the next few days the laceration bled intermittently. His condition was apparently stable thereafter until three days before admission, when a severe occipital headache developed and was accompanied by pain in both temporomandibular joints. He took two aspirins every four hours, without relief of pain. On the day of . . .

Presentation of Case First admission. A 60-year-old woman was admitted to the hospital because of congenital heart disease. A heart murmur and skeletal anomalies were noted shortly after birth. Her early years were uneventful and free of symptoms. At the age of 39 years dyspnea developed, and atrial fibrillation was found; digitoxin was prescribed. Several years before admission exertional dyspnea increased in severity, and furosemide was prescribed. Five years before entry an echocardiogram demonstrated findings consistent with an atrial septal defect with right ventricular volume overload and pulmonary hypertension; a question of tricuspid prolapse was raised. Two years before . . .

Presentation of Case An 80-year-old woman was admitted to the hospital because of dyspnea. She was well until three years earlier, when she began to have episodes of diplopia, dizziness and faintness when stooping or working in a hot environment. On one occasion she fainted; a physician found a heart murmur. Two years before admission these episodes ceased. Twenty-one months before entry she began to have gradually increasing exertional dyspnea, followed by paroxysmal nocturnal dyspnea and edema. One month later she entered another hospital, where a diagnosis of aortic stenosis with congestive heart failure was made. Digoxin and hydrochlorothiazide were . . .

Presentation of Case A five-year-old boy was admitted to the hospital because of meningitis. He was well until 10 days previously, when a sore throat and fever developed. He was seen at another hos...

Presentation of Case A 3 1/2-year-old girl was admitted to the hospital because of congestive heart failure. She was well until two months previously, when symptoms of a respiratory-tract infection developed. Five days later her parents observed pallor and cyanosis of her lips. A physician found signs of congestive heart failure and admitted her to another hospital. Routine laboratory studies were reported to be negative; a throat culture yielded no beta-hemolytic streptococci. Agglutination studies disclosed a 10-fold rise in antibodies to influenza A/Port Chalmers/1/73 strain. She improved and one month before entry was discharged home on a regimen of bed . . .

Presentation of Case An 82-year-old man was admitted to the hospital because of suspected failure of his electronic pacemaker. He was well until five years earlier, when left hemiparesis developed, and he was admitted to the hospital. On the second hospital day cardiac arrest occurred, and he was resuscitated. Persistent ventricular ectopic activity was poorly controlled by multiple medications, and a transvenous electronic pacemaker was inserted, with improvement. A permanent atrial electrode was positioned in the coronary sinus, with a programmable pacemaker set at 90 beats per minute, and the patient was discharged. Digoxin and small doses of quinidine controlled . . .

Presentation of Case A 38-year-old woman was admitted to the hospital because of a pericardial effusion. Nine years earlier she was told that she had asymptomatic aortic stenosis and slight cardiac...

Presentation of Case A 33-year-old man was admitted to the hospital because of congenital heart disease. Intermittent cyanosis of the lips was noted in early childhood, and examination disclosed a murmur. He was seen at this hospital on three occasions before the age of seven years because of recurrent pneumonitis. An ophthalmologist found bilateral microphthalmia with blepharoptosis. Twenty-five years before admission right-sided cardiac catheterization revealed that the pressure was 60/20 mm Hg in the pulmonary artery, 60/0 mm Hg in the right ventricle, and 0 mm Hg in the right atrium. The oxygen content was 12.7 vol per cent in . . .

Presentation of Case A 35-year-old woman was admitted to the hospital because of chest pain. She was well until 14 years previously, when she began to experience wheezing on exertion. Aminophylline was prescribed, with improvement. Four years before admission the wheezing increased, with weakness, weight loss, nocturnal sweats, and rise of the temperature to 38.1°C. A cough productive of yellow sputum developed, and mild anterior chest pain and dyspnea occurred. She was admitted to this hospital. X-ray films of the chest (Fig. 1) showed patchy infiltrates in both upper lobes; an azygos lobe was present; the heart was not enlarged. . . .

Presentation of Case A 42-year-old woman was admitted to the hospital under cardiopulmonary resuscitation. She was first seen in the clinic at the age of nine years because of infrequent nocturnal ...

Presentation of Case A 26-year-old woman was admitted to the hospital because of heart murmurs. There was a history of scarlet fever at the age of seven years. At 21 years a cardiac murmur was hear...

Presentation of Case A 69-year-old woman was admitted to the hospital because of melena. Twenty years earlier a diagnosis of hypothyroidism was made, and desiccated thyroid, 3 g daily, was prescrib...

Presentation of Case A 58-year-old man was admitted to the hospital because of dyspnea and anasarca. He was well until eight years previously, when an enlarged right cervical lymph node was found. ...

Presentation of Case A 66-year-old man was admitted to the hospital because of hemoptysis. There was a long history of ischemic heart disease, with four episodes of myocardial infarction between six and 19 years earlier. Thirty-four months before admission a triple coronary-artery-bypass graft was performed elsewhere, with an aneurysmectomy of the inferior wall of the left ventricle. Exertional angina pectoris continued but was diminished in frequency and severity. Two years before admission he came to this hospital because of reflex sympathetic dystrophy of the left arm; an injection into the left stellate ganglion resulted in improvement. Two months later a . . .

Presentation of Case A 44-year-old woman was admitted to the hospital because of chest pain. She was well until the afternoon before admission, when she was informed that her 17-year-old son had co...

Presentation of Case A 55-year-old man was admitted to the hospital because of intermittent claudication of the arms. He was well until five years earlier, when a diagnosis of diabetes mellitus was made. Dieting resulted in a weight reduction from 90 to 68.2 kg. On a routine annual physical examination 10 weeks before admission the radial and brachial pulses were found to be diminished bilaterally. One month before entry he began to have weakness and pain in both hands and forearms on minor exertion such as tying his necktie, shaving, or completing a single-page government form, with recovery after several . . .