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Hammock valve, also known as anomalous mitral arcade is a rare mechanism for congenital mitral insufficiency. We report a case of a two-week-old neonate who presented with features of heart failure and an apical systolic murmur. Echocardiogram showed severe mitral regurgitation and abnormal mitral valve with direct attachment of mitral leaflets to papillary muscle without intervening chordae tendinae, typical of hammock valve. Heart failure was controlled with ionotrpes and diuretics. The literature on the hammock mitral valve is reviewed.

Presentation of Case A 75-year-old man was admitted to the hospital because of a colonic carcinoma, right ventricular mass, and pleuritic chest pains. The patient was in vigorous health three months earlier, when a physical examination was normal; he continued to play tennis doubles regularly and to take part in ballroom dancing. A stool specimen gave a negative test for occult blood. One month later he had a "boring," nonpleuritic pain in the left scapular region. His physician heard a Grade 2 apical systolic murmur for the first time; the lungs were clear. Radiographs of the chest revealed slight prominence . . .

A retrospective study was performed in the Cardiology Unit of Alfort in 451 Cavalier King Charles (CKC) spaniels. A left apical systolic murmur was detected in 183 of them (40.6 %). The prevalence of the murmur increased with age (18.8 % for CKC < 1 year old to 100 % for CKC > 11 years old). Mitral valve endocardiosis represented 93.3 % of the ultrasound anomalies. There was a positive correlation between age and several echo-Doppler parameters (P< 0.01) : atrium/ aorta ratio, diastolic left ventricular diameter, thickness of the mitral valve leaflets, and mitral regurgitant mapping area. A positive correlation was also noted between the intensity of the murmur and these echo-Doppler parameters (P< 0.0001). In conclusion, mitral valve endocardiosis is a frequent valvulopathy which occurs at an early age in CKC spaniels in France. Several clinical and echo-Doppler parameters have a predictive value for the severity of the disease., Une étude rétrospective a été menée dans l’Unité de Cardiologie d’Alfort chez 451 Cavaliers King Charles (CKC). Un souffle systolique apexien gauche a été détecté chez 183 d’entre eux (40,6 %). La prévalence de ce souffle augmentait avec l’âge (18,8 % pour les CKC < 1 an à 100 % pour les CKC > 11 ans). L’endocardiose valvulaire mitrale a représenté 93,3 % des anomalies diagnostiquées à l’échocardiographie. Une corrélation positive a été observée entre l’âge et différents paramètres échographiques (P< 0,01) : le rapport atrium/ aorte, le diamètre diastolique ventriculaire gauche, l’épaisseur des feuillets mitraux et la surface colorimétrique du reflux mitral. Une corrélation positive a aussi été observée entre l’intensité du souffle et ces paramètres échographiques (P< 0,0001). En conclusion, l’endocardiose mitrale est une valvulopathie à la fois précoce et fréquente chez le CKC en France. Certains paramètres cliniques et écho-Doppler ont une valeur prédictive de la gravité de la maladie., Chetboul Valérie, Tissier Renaud, Villaret Florence, Nicolle Audrey, Dean Eric, Benalloul Thierry, Laforge Hervé, Pouchelon Jean-Louis. Endocardiose mitrale de l'épagneul Cavalier King Charles en France: étude épidémiologique, clinique et écho-Doppler de 451 cas. In: Bulletin de l'Académie Vétérinaire de France tome 157 n°1, 2004. pp. 81-86.

Sir, The recognition and correct interpretation of systolic murmurs is indeed fundamental to the early diagnosis of aortic stenosis,1 even when the initial perception is that the murmur originates from the mitral valve, since mitral regurgitation may itself be a defining characteristic of severe aortic stenosis,2 the aortic murmur sometimes even decreasing in …

A 6 year old girl with apical systolic murmur underwent transthoracic two dimensional colour Doppler echocardiography. An isolated mild mitral regurgitation was noticed. The mitral regurgitant jet emanated …

Presentation of Case A 74-year-old woman was admitted to the hospital because of a radiologic abnormality of the left kidney. She was well until six weeks earlier, when she began to have an intermittent rise of the temperature to 38.3°C, accompanied by malaise, listlessness, and pain in the left flank. Five days before admission she entered another hospital. On examination she appeared well apart from overweight and mild pallor. A Grade 1 apical systolic murmur was heard. Abdominal, pelvic, and rectal examinations were negative. The urine was normal except that the sediment contained 12 white cells per high-power field. The . . .

Congenital left atrial aneurysm is a rare anomaly that has been reported only five times previously. The usual presenting features include an abnormal chest roentgenogram, an apical systolic murmur and supraventricular tachycardia. Even with cineangiocardiography the diagnosis is uncertain, and the lesion is commonly confused with cardiac tumor. Aneurysmectomy is the preferred treatment and has been successful in all patients undergoing operation. The presence of thrombi in the aneurysm necessitates circulatory assistance during excision.

These studies have confirmed the presence of late mitral regurgitation associated with a peculiar deformity of the mitral valve in patients with a late apical systolic murmur. This lesion is not always innocuous, however, as 4 of 8 of our patients have a severe degree of mitral regurgitation, 2 of them also having a significant amount of left ventricular and left atrial enlargement. In addition, in 1 patient with similar clinical findings bacterial endocarditis has developed. Evidence for a congenital origin of this lesion in some of these patients is also presented.

PRESENTATION OF CASE A 45-year-old man was admitted to the hospital because of dyspnea. At the age of 10 years he had scarlet fever; he was advised to limit his activities because of a cardiac murmur. Fifteen years before admission he was treated for subacute bacterial endocarditis; examination disclosed a Grade 4 apical systolic murmur and a questionable Grade 1 apical diastolic murmur. Seven years before entry atrial fibrillation developed; digitalis and penicillin were prescribed, and he was admitted to another hospital, where physical examination revealed a Grade 4 pansystolic murmur at the cardiac apex that radiated to the left . . .

A false left ventricular aneurysm developed during a seven month period following acute anterolateral myocardial infarction in a 54-year-old man. An apical systolic murmur which simulated mitral regurgitation was present; however, the left ventriculogram demonstrated no valvular insufficiency. Instead, the contrast was observed to fill a false ventricular aneurysm via its small communication with the left ventricle. Clinical recognition of this entity is emphasized as well as the importance of surgical resection once the diagnosis of false ventricular aneurysm has been established.

Eight patients with tight mitral stenosis and associated tricuspid insufficiency are presented. Initially, significant mitral insufficiency was suspected because of a loud apical systolic murmur, which after careful re-evaluation was proved to be of tricuspid origin transmitted to the apex. Mitral commissurotomy was performed in 7 cases, and tight mitral stenosis without mitral insufficiency was found; tricuspid insufficiency of considerable degree was noted in all. These cases prove that the murmur of tricuspid insufficiency can be heard at the apex or beyond, where the systolic murmur of mitral insufficiency is usually expected, and thus an erroneous diagnosis of mitral insufficiency can be made. Taking into consideration that a mitral commissurotomy is not indicated in the presence of mitral insufficiency, one should search carefully for those cases with tight mitral stenosis and associated tricuspid insufficiency masquerading as mitral insufficiency.

Sinus tachycardia is generally regarded as a symptom and treatment is directed toward the underlying disorder rather than to the tachycardia as such. However, cases are encountered where the cause of the rapid heart action is not clear, or if evident not readily reversible. Under such circumstances, in our experience, no satisfactory measure for the control of the tachycardia has heretofore been available. Recently it occurred to us that guanethidine (Ismelin), because of its bradycardic properties, might merit a trial. Report of Cases Case 1. —A 60-year-old woman was first seen on Aug 15, 1955, complaining of palpitation and substernal distress of two to three month's duration. She had been receiving digitalis daily without relief. Examination showed a regular tachycardia with a pulse rate of 110 to 120 beats per minute. The heart was within normal limits in size and shape. There was a short apical systolic murmur; the heart

IN PREVIOUS reports 1 it has been pointed out that the true significance of the relationship of apical systolic murmur to underlying cardiac disease has not received due recognition. The consequences of failure to evaluate properly apical systolic murmur was brought to my attention during the late war, and it is to emphasize the result of underestimating this sign that additional material is presented. While serving with the navy, I saw in consultation large numbers of naval personnel in whom the sole objective symptom was a loud systolic murmur at the apex. In none of the cases was there enlargement of the heart; diastolic murmurs were not heard, electrocardiograms were not abnormal and signs of heart failure were not present. Yet the men and women concerned had been on the sick list for days, weeks or months. To the National Naval Medical Center at Bethesda, Md., which in the first

Mr. —, merchant, 73 years old, of good habits and good family history, came under my care in September last. His health had not been robust for many months. In midsummer his legs became edematous and he then first consulted a physician. He was found to have dilatation of the heart, a slight aortic murmur, atheroma to a moderate extent of the peripheral arteries and interstitial nephritis. His symptoms underwent no material change up to September, when I first saw him. As time went on he grew feebler, thinner and mentally depressed. He had little appetite for food or drink. He was often sleepless. About the middle of October he was too feeble to walk, and rarely slept more than an hour at a time. At night he was tormented by hallucinations which were very persistent. At this time Cheyne-Stokes respiration first manifested itself. The rhythmically increasing and diminishing respiratory

The neurilemoma, a benign nerve sheath tumor, has been reported in the orbit a number of times.1Intraocular examples, however, are rare. The following case is reported for this reason, and, in addition, the clinical history is of considerable interest, since the tumor in this instance closely simulated an intraocular malignant melanoma. REPORT OF A CASE A 68-year-old white woman, was admitted to Strong Memorial Hospital on Nov. 14, 1949, for a cataract extraction. Her only complaint was impaired visual acuity at distance and near in the right eye. This was first noted about two years previously. Positive physical findings were limited to the chest, where a faint apical systolic murmur was heard. The ocular examination showed a corrected visual acuity of 20/200 O. D. and 20/30 -4 O. S. The external structures were normal; the pupils were of equal size and reacted promptly to light. Slit-lamp examination revealed

Excerpt The diagnosis of mitral insufficiency is not difficult in most patients. However, determining the hemodynamic importance of an apical systolic murmur associated with mitral stenosis, aortic...

The following two cases of complete heart-block are considered worthy of report because of several unusual features shown by electrocardiograms. REPORT OF CASES Case 1. —Mrs. E. P., an American housewife, aged 39, had been under observation in the Washington University Dispensary for two years. She first came to the dispensary because of various gynecologic complaints associated with retroversion of the uterus. At that time it was found that she had an unusually slow pulse rate, and electrocardiograms revealed the presence of complete heart-block. This condition had been constantly present since, but in spite of this fact she had had no cardiac symptoms aside from slight dyspnea on exertion. She had never had a syncopal attack. Physical examination of her heart had constantly shown moderate enlargement of the cardiac dulness, the presence of an apical systolic murmur transmitted to the axilla, and a faint aortic systolic murmur poorly transmitted. The