Case 29-1969

Presentation of CaseA seventy-four-year-old man was admitted to the hospital because of subcutaneous hemorrhages of the scrotum, thighs and flanks.Twenty years previously admission to another hospital was occasioned by an acute episode of orthopnea and dyspnea, without chest pain. An electrocardiogram showed atrial fibrillation and runs of ectopic ventricular beats, and an x-ray film of the chest demonstrated generalized cardiac enlargement and clear lung fields. With quinidine and digitalis therapy the dyspnea subsided, and a normal cardiac rhythm was restored. After discharge he experienced moderate dyspnea on exertion, without orthopnea, nocturnal dyspnea, ankle edema or chest pain. He . . .