Cardiomyopathy in four members of a family.

We are describing briefly another family with cardiomyopathy, where a woman and three of her four children were affected. Some of them have been under observation for twelve years and have been examined by the three authors at different periods. The mother had been suspected for many years of having some form of congenital heart disease because of a murmur. She and her three affected children were seen in 1948-51 at Liverpool by E.W.J.: he was impressed by the triple rhythm and by the mitral shape of the heart but did not think they had mitral stenosis. Later in 1950 one of the boys, then aged 15, died while playing football though he had been advised not to play. His mother died in 1952, at the age of47 with cardiomyopathy, a large heart, atrial fibrillation, and intracardiac thrombosis. In 1956, the two survivors, the sister and the youngest brother were seen by M.C. at Guy's Hospital. They were admitted for catheterization but permission for this was withdrawn so there was only a clinical examination. Triple rhythm was still one of the most striking features, and the diagnosis was thought to be familial cardiomyopathy. The youngest brother died suddenly when walking in the street at the age of 17 in 1960. This death and the occurrence of congestive heart failure in the sister after a successful pregnancy led to her admission under J.M.B. at Birmingham for cardiac catheterization. This revealed no congenital structural malformation but some left ventricular insufficiency on exercise and so supported the diagnosis of cardiomyopathy. She was given quinidine to try to prevent the occurrence of serious arrhythmias, and has remained reasonably well for 20 months but her outlook must be uncertain. A son of the mother's brother, a first cousin of the three sibs, died suddenly from heart disease when he was 42 but he had complained of anginal pain for four years so he may not have had a cardiomyopathy. The other members of the family appear to be free from heart disease.