Pulmonary vascular engorgement in a 65-year-old woman.

~ O I L . I Z , Rhode Island 02852 failure. The carotid pulses were brisk, but collapsed in midsystole. The cardiac apical impulse was hyperkinetic with a diffuse precordial systolic thrill. A third heart sound was present. There was a grade 4 of 6 harsh holosystolic murmur maximal at the left sternal border in the third interspace, but audible across the entire precordium. A grade 1 of 6 decrescendo diastolic murmur was present at the base. To some examiners, the thrill suggested ruptured chordae tendinae. VDRL serology was positive. These chest films were obtained after cardiac compensation had been restored.