A memorable patient: All in the family

In the early 1950s I was a registrar at the special unit for juvenile rheumatism, a part of the Canadian Red Cross Memorial Hospital, Taplow, Buckinghamshire. This general hospital also housed adult cardiac patients. In those more leisurely days a morning coffee break was customary to discuss patients, research, and other projects. On one such break I presented my chief, Paul Wood, who was then the eminent British cardiologist, with an electrocardiogram for his opinion. After a quick glance he said “a classical inferior infarct, what’s the problem?” I replied that the problem was that the patient happened to be a 10 year old girl with rheumatic fever. Wood blanched, threw his coffee at me, and changed the subject. Some years later I was telephoned at the Institute of Cardiology by my opposite number at the Hammersmith Hospital to ask if I remembered this girl. He told me that her brother had just been diagnosed as suffering from the newly described asymmetrical hypertrophy of the heart and he was investigating the family for any familial trend and found my former patient. This condition had recently been recognised from necropsy studies by Donald Teare.1 Clinical recognition was in its early stages and my girl’s electrocardiogram changes were typical of the pathology, now better known as hypertrophic obstructive cardiomyopathy or HOCM, which has a strong familial prevalence.