Case 7-1981

Presentation of CaseA 55-year-old man was admitted to the hospital because of hemoptysis.He was well until two years earlier, when hyper-tension was found, and hydrochlorothiazide was administered. Six months before entry a routine physical examination was negative; no murmur was heard. One month before admission another routine examination by a second physician revealed a Grade 3 systolic murmur. An electrocardiogram and an x-ray film of the chest were normal. Four days before entry the patient experienced an abrupt onset of substernal "heaviness" that radiated to the left shoulder and back, accompanied by persistent dyspnea. One day later a . . .