Site Search     
Proceedings Logo
Past Issue:
Volume 20, Number 4 • October 2007		 Arrow Bullet Return to Table of Contents
Arrow Bullet PDF of this Article

Sequential heart murmurs in a 43-year-old man with congenital heart disease

D. Luke Glancy, MD, Frank E. Wilklow, MD, Sai K. Devarapalli, MD, Pramilla N. Subramaniam, MD, and Nick M. Moustoukas, MD

Since the article has no abstract, the first 150 words are shown.

Within a week of this patient's birth, a physician discovered a loud systolic murmur. When the patient was 14 years old, the murmur disappeared. He developed a second murmur when in his mid-30s. At age 43, some 6 months before admission, he noted dyspnea on exertion, which became worse during the month prior to his hospital admission. He was never cyanotic.

His pulse was 80 beats per minute and regular; his blood pressure, 152/72 mm Hg; and his respiratory rate, 18 breaths per minute. Breath sounds were normal. There was no cyanosis, clubbing, edema, or sign of infective endocarditis. The carotid pulses were fuller and brisker than normal. The left ventricular impulse was prominent with the patient on his left side. No gallop could be heard. A continuous murmur with a peak in intensity in systole and another in diastole was loudest in the third left intercostal space. The admission electrocardiogram showed left ventricular enlargement (Figure) (1-3).