At autopsy the pericardial sac contained clotted blood. The heart weighed 520 g and the left ventricle measured 2 cm in thickness. A rupture of the lateral wall of the left ventricle was noticed. All three coronary arteries were stenosed over 75% and the left circumflex coronary artery contained a thrombus completely occluding its lumen.
Case 2 Rheumatic carditis
A 35-year old woman with unknown history of rheumatic heart disease came to the hospital in marked respiratory distress, short of breath, wheezing and gasping for air. She was red in her face and had distended neck veins. The liver was enlarged and painful, and the legs edematous and pale. On physical examination blood pressure was normal. A prominent systolic heart murmur, loudest at the apex, radiating to the axilla and a prominent third heart sound were heard. X-ray disclosed mottling of the lungs, marked enlargement of the heart, and calcification of the mitral valve. She was treated medically and after she became compensated her mitral valve was replaced with a mechanical valve.Discussion Topics
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Case 3 Bacterial Endocarditis
A 40-year old man with a history of childhood rheumatic fever noted recent weight loss, fatigue, low grade fever, muscle pains and abdominal heaviness. On admission, tachycardia with an ejection murmur over the aortic area were the most prominent findings. The blood pressure was normal. Leukocytosis was the only laboratory abnormality. On x-ray the heart appeared enlarged and the lungs were congested. There was hepatosplenomegaly and pedal edema. Blood cultures yielded Streptococcus viridans. The patient was treated with antibiotics and after the infection was controlled he underwent vulvular replacement.Discussion Topics
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Case 4 Hypertensive heart disease
A 60 year old man with a 20-year history of arterial hypertension in the range of 160/100 mm Hg was hospitalized because of dizziness, nausea, widespread edema and severe shortness of breath. Clinical diagnoses included cardiomegaly, pulmonary edema, congestion of the liver with hepatomegaly, ascites and anasarca. Elevated central venous pressure and arterial pressure were found. Eye grounds showed hypertensive changes and the neurologic examination revealed a possible left hemispheral lesion. The next day he lost consciousness and died presumably of a stroke.Discussion Topics
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Chest x-ray disclosed "bat-wing" like infiltrates around pulmonary artery, haziness of hilar vasculature and Kerley B horizontal lines. Cardiomegaly was also noted. He responded initially well to digitalis, but two weeks later his condition deteriorated and he was scheduled for a heart transplantation.
Case 5 Viral myocarditis
A 40 year old man was hospitalized because of shortness of breath that evolved progressively over a period of 10 days. He was healthy until approximately 3 weeks prior to hospitalization when he had a severe "flu" and he felt so bad that he had to stay home in bed for 3 days. The "flu" was accompanied by severe muscle pain and he felt exhausted and tired ever since. He also noticed swelling of his legs, a dull belly pain especially underneath the right chest wall margin. On physical examination his pulse rate was 130/min., blood pressure 90/60 mm Hg and the rate of respiration 30 per minute. The auscultation of the heart revealed a prominent S 3 gallop and laterally displaced point of maximal impulse. An ECG disclosed atrial fibrillation and minor non-specific changes of the S-T segment. The liver and spleen were enlarged. There was pitting edema.Discussion Topics
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