Case 59-1963

Abstract
Presentation of Case First admission. A fifty-nine-year-old man entered the hospital because of dyspnea.Nine years before admission the patient became aware of gradually progressive dyspnea accompanied by aching in the forearms and calves; the symptoms appeared during walking and were relieved with rest. Two years later he was said to have congestive heart failure with a systolic murmur, and an electrocardiogram was interpreted as showing right ventricular strain and atrial enlargement; digitalis therapy was begun, but had little effect. During the seven years before entry he experienced pruritus after taking a bath. Shortly before admission he was informed . . .

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