Cyanotic Malformations of the Heart with Pheochromocytonma

R.D. (JHH no. A 511024), a 26-year-old wh te man, who, although cyanotic at birth, was acyanotic during early childhood, grewv and developed well and only suffered mild to moderate exertional dyspnea. At 7 years of age, cyanosis reappeared, squatting became apparent, and the dyspnea and fatigability increased. In spite of these sympitoms the patient finished high school and was able to perform light farm chores. By age 18 the cyanosis had become persistent. In 1949, at the age of 26, he was referred to the Harriet Lane Home because of severe incapacity. On examination, the blood pressure was 140 80 mm. Hg, pulse 80, respiratory rate 20, and temperature 39 C. The patient was small in stature, undernourished, and deeply cyanotic, and the digits were severely clubbed. A systolic thrill and murmur, most prominent in the third left