Sudden Dysphagia in Acute Myocardial Infarction

To the Editor.— Difficulties in swallowing are rarely caused by cardiovascular diseases. In patients with chronic mitral valvar lesions such symptoms have occasionally resulted from direct mechanical compression of the esophagus by the elevated pressure in the dilated left atrium.¹In a patient with sudden and complete esophageal obstruction, total inability to swallow showed a close and reversible connection with paroxysms of atrial fibrillation. A radiological study verified compression of the lower esophagus by the heart. Acute left heart failure secondary to extensive myocardial infarction as the cause has apparently not been observed. Report of a Case.— A 60-year-old carpenter was healthy until a mild angina pectoris appeared ten months prior to admission. At the intensive care unit of this hospital he complained of acute pains in the chest and breathlessness. An extensive fresh anterior myocardial infarction was shown by the electrocardiogram (Figure). The enzyme levels were high; serum