Just What the Doctor Ordered

CASE OF TEMPORAL ARTERITIS MEDIALJSRNAL 293almost certainly suffered a diffuse enlargement of his aorta.I think it is only coincidence that your diagnosis of " dissecting " aneurysm instead of "dilating" aneurysm is correct.WHIEN TO SUSPECT DISSECTION Dr. GOODWIN: One of the difficulties here, I think, and one which is not uncommon, is the fact that when you have hypertrophy of both ventricles the cardiographic diagnosis of infarction may be very difficult.It may be obscured, or it may be counterfeited.On looking through these tracings it is clear, as Dr. Cope has said, that this man never had unequivocal evidence of myocardial infarction.He undoubtedly had myocardial damage and biventricular hypertrophy.That is why I was interested in whether his right ventricle also was enlarged.I think a guiding principle upon which we should work is that, if somebody who is hypertensive has rather atypical chest pain, and a cairdiogram which is no, absolutely diagnostic of cardiac infarction, he may well have a dissection.Dr. COPE: I think we ought to put on record the actual facts about the anticoagulant therapy.I see from the treatment sheets that he was given heparin for one day and part of the second day and then the treatment was cancelled.Two or three weeks later, he was again ordered heparin, presumably for one of these subsequentattacks, but it was deleted and not given.So in fact it was not more than a cotuple of days of anticoagulant therapy, but it might have b.-n an aetiological factor nevertheless.We are grateful to Dr.