Left Ventricular Aneurysm in a Bantu Child.

The 12-year-old patient stated that she had been completely well until five months before her visit to this Clinic on January 29, 1963. At that time her ankle and elbow joints had become painful and swollen. A few days later she developed sudden severe precordial pain which lasted about 12 hours and was associated with sweating and breathlessness. She was admitted to another hospital where her sedimentation rate was found to be raised (31 mm./hour, Wintrobe) and a diagnosis of rheumatic fever was made. The polyarthritis and chest pain improved on penicillin, salicylate, and corticosteroid therapy. She was referred to this clinic for an assessment of her cardiac condition. Examination revealed a well-nourished Bantu girl with a somewhat "moon-face" due to the steroid therapy. The only other abnormal findings were in the cardiovascular system. Her pulse rate was 75 a minute, regular, and of normal volume. Her blood pressure was 120/70 mm. Hg. The jugular venous pulsations were normal. The apex beat was displaced to the sixth intercostal space just outside the midclavicular line and was left ventricular in type. No abnormal impulses were detected in the region of the cardiac apex. On auscultation a very short, loud and musical systolic murmur was heard near the apex (Fig. 1). This murmur increased in intensity when the patient lay on her left side but varied considerably with respiration and was best heard during held mid-inspiration. A systolic click sometimes occurred in the middle of this short systolic murmur. A short but moderately loud early diastolic murmur was present at the sternal border. The second heart sound was normal. The electrocardiogram showed an axis of + 200. T wave inversion was present in all the precordial leads but there was no evidence of ventricular hypertrophy. A postero-anterior teleradiogram indicated slight cardiomegaly (cardio-thoracic ratio of 53%4) and a rounded protruberance in the region of the apex of the,