MUTE MITRAL STENOSIS, MYOCARDIAL INFARCTIONS, AND ISCHEMIC GANGRENE IN OLD AGE: CASE REPORT.

An unusual case of associated cardiovascular disease is presented. A 64-yearold diabetic, arterioselerotic and hypertensive patient had an episode of pulmonary edema with vascular collapse followed by bilateral gangrene of the lower limbs. A second episode caused death. Autopsy revealed: (1) rheumatic heart disease with tight mitral stenosis; (2) coronary heart disease with an old and a recent infarct; (3) left atrial thrombosis resulting in multiple embolisms (one old—cerebral; one recent—of the iliac arteries); (4) arteriosclerosis obliterans. Mitral stenosis was silent, as proved by auscultation and phonocardiography. Electrocardiography failed to undisputedly reveal the infarcts (one was old, the other, terminal). Surgery showed that the gangrene was not due to embolism (a saddle- or double-embolus took place only in the terminal stage). [ABSTRACT FROM AUTHOR]