The Neurohypophysis

Abstract

pulmonary embcÏÏus, may be forgotten once the diagnosis has been assured. The cases reported have required no treatment except some cases requiring medication for relief of pain.My case will be reported briefly, as follows : P. K., a well developed and nourished lawyer, walked into the Bluefield Sanitarium Hospital, Aug. 12, 1940, com-plaining chiefly of his heart thumping and of the associated clicking with each beat. His past history was noncontributory except possibly for a severe case of whooping cough at 12 years, which, he stated, nearly killed him. He had been feeling perfectly well until August 10, when he awakened about 3 a. m. with paroxysms of coughing that lasted off and on for two hours, interrupting his sleep. This was unusual for him. On awakening again about 8 o'clock he turned on his left side and became conscious of noisy thumping of his heart. He was able to work August 10, although this painful thumping and noise, which even his friends were easily able to hear, persisted. These queer sensations continued on the following day, but by then he was able to gain some relief by deep inspiration or stretching. Becoming very worried about himself, he came to the hospital along with his anxious family, insisting ihat he had severe heart trouble. A member of our medical staff jokingly reassured him and in turn was amazed when the man turned on his left side and, even while seated at his desk across the room, the physician was able to hear a loud rhythmic crunching noise. On examination the sounds were found to be synchronous with each heart beat.On examination the patient, who was robust, was in no acute distress but rather apprehensive. He is an intelligent man. The blood pressure was 124 systolic and 74 diastolic, the pulse rate 80 and the temperature 99 F. There was no evidence of subcutaneous emphysema about his neck or shoulders and no evidence of pneumothorax. A percussion note was hyperresonant over the precordial area. The heart sounds were normal with the patient lying flat, but when he turned on the left side a loud clicking, crunching sound could be easily heard over the entire precordium which was almost painful to the ear. This sound was loud on expiration but disappeared entirely on deep inspiration. The noise was constantly present with each cardiac systole under the aforementioned conditions. At times, however, over the apical area a sound which might have been interpreted as a harsh diastolic murmur would come and go during expiration. The patient also demonstrated his ability to produce these former sounds by bending forward while standing. The physical examination was otherwise negative. A roentgen examination revealed the heart and great vessels to be normal, with no evidence of pneumothorax. The leukocyte count was 7,200. The sedimentation rate was 5 mm. in one hour. An electrocardiogram was normal.Fortunately I had a copy of Dr. Hamman's report, and the diagnosis became obvious. The patient was more relieved after reading this reprint than with any assurance I could give him. Afte...