Presentation of Case First admission. A forty-three-year-old man entered the hospital because of exertional dyspnea, orthopnea and peripheral edema of ten weeks' duration.Four months before admission he had an upper respiratory infection, with a nonproductive cough and pleuritic pain in the left side of the chest and substernal region. X-ray films of the chest demonstrated cardiac, enlargement and fluid in the left pleural cavity. He improved with diuretic therapy.When he was twenty-seven years old the patient had a sore throat followed by migratory arthritis, with hot, swollen joints for three months. Ten years later he experienced a similar . . .