Dextrocardia with Pulmonary Stenosis and Functionally

A 34-year-old Puerto Rican w-as admitted to Lincoln Hospital February 10, 1956, complaining of chest pains, vomiting, marked dyspnea, and ankle edema. According to the mother, the childmwas normal at birth and developed normally to about the age of 8. Then he began to develop a deformity of his back and to show cyanosis. Dyspnea on exertion, cyanosis, and deformity of the back became progressively worse, but he was not under any continuous medical care. Examination at the time of admission revealed an acutely ill, markedly dyspneic, and cyanotic man. There was marked deformity of the thoracic cavity due to kyphoscoliosis of the dorsal spine with a convexity to the left. The blood pressure was 100/60. The heart rate was very rapid and irregular. There was a grade IV, rough systolic murmur and a long blowing diastolic murmur at the fourth left interspace, and a grade IV systolic murmur over the second left interspace. MIoist rales were heard throughout both lung fields. There was heaving over the entire precordial area and a point of maximum cardiac impulse could not be determined. The thrust to the right of the sternum appeared to be greater than to the left. The liver was enlarged 4 fingers below the left costal margin. There was 3+ pitting edema of the extremities. Fluoroscopy and x-ray of the heart were confusing because of the kyphoscoliosis. The aorta was to the right of the esophagus and the transverse diameter of the heat was increased. The stomach was in the right upper quadrant (fig. 1). The electrocardiogram (fig. 2) was most difficult to interpret. Atrial fibrillation with a very rapid ventricular rate and digitalis effect were definite. There was no definite evidence of dextrocardia. The hemoglobin was 15 Gm. per cent and the white count was 6,400, with a normal differential. The urea nitrogen was 28 mg. per cent. Other tests were within normal limits. The patient was treated with digitalis, mercurials, quinidine, and a salt-free diet, and the decompensation improved. However, on April 14, he complained of pains in the chest and marked dyspnea, went into shock, and died.