Extreme cardiac hypertrophy: Report of two cases with aortic hypoplasia and endocrine disorders

Abstract

Cardiac hypertrophy exceeding 1000 grams in weight is rare. Golden and Brams (1937) could only find 37 cases recorded, excluding the 9 that they themselves reported. They did not include in their survey the cases occurring in acromegaly, to which Courville and Mason (1938) drew attention. In the two cases here reported the hearts weighed 1350 and 900 grams respectively and were associated with aortic hypoplasia and disorders of the endocrine system, one having diabetes mellitus, the other an interauricular septal defect and acromegaly. NOTES OF FIRST CASEThis man had suffered with chronic nasal infection for many years and in 1935 he underwent drainage of the left frontal sinus. In 1936, when 28 years old, he began to lose weight and to be extremely thirsty; diabetes mellitus was diagnosed. He was treated with 60 units of soluble insulin and a diet containing 90 g. of carbohydrate daily.He first attended the diabetic clinic of the Birmingham United Hospital in November, 1937.The same dietary and insulin regime was continued. Physical examination at that time showed a wellbuilt man, 5 ft. 10 in. tall and 141 lb. in weight. The heart was enlarged and there was a systolic murmur and thrill of moderate intensity, just internal to the apex beat. The rhythm was regular at a rate of 80-85 beats a minute and the blood pressure varied between 100/70 and 120/80. At the diabetic clinic his blood sugar rose to between 300 and 400 mg. per 100 c.c. after lunch, but in spite of this he felt well and was able to do heavy work as a foundry worker. Six months later, however, on the same dosage of insulin and diet he began to have frequent hypoglycxmic attacks and for the next six months he was stabilized with 30 units daily, but then the blood sugar levels again climbed to between 300-400 mg. per 100 c.c. with no obvious change in the patient's well being. In 1938 he was admitted to hospital on account of hypoglycaemic coma, and careful examination at that time suggested a diagnosis of interventricular septal defect. The electrocardiogram showed a normal P-R interval, marked left axis deviation, and inverted T waves in leads I and II. Radioscopy showed the transverse measurement of the heart was 16 5 cm., with a chest diameter of 29 5 cm. (Fig. 1). Physical examination did not show any change and the blood pressure still remained at the same level.In July, 1940, he was again admitted for investigation. He was then complaining of marked weakness and inability to work over the previous five weeks. He had noted, also, profuse sweating even when at rest and some breathlessness and palpitations on exertion. Again, physical examination was essentially as before, his Wasserman was negative, while his basal metabolic rate was +28 per cent with a basal pulse rate of 88.At this time he was taking 150 g. of carbohydrate and 25 units of soluble insulin twice a day. He was treated with rest in bed and improved rapidly. After this he gave up his job as a foundry worker and took on that of a bread salesman. In January, 1941, he was admitted w...