Aneurysm of the coronary arteries.

A retired butcher, aged 66, gave a history of increasing breathlessness for one year. He also had occasional sharp pain in the chest, not typically anginal. On examination, he was cyanotic and orthopnceic and had consolidation of the upper lobe of the right lung, with bilateral basal crepitations. No clinical abnormality was noted in the heart, but an X-ray was reported as showing cardiac enlargement. Three days later his dyspncea had increased and he complained of severe pain down both arms and across the chest. His blood pressure at this time was 100/65; he had