Flutter of the atria ("Vorhofsflattern)

In September 1920, a patient was admitted to the therapeutic department of the Clinical Institute with symptoms of severe shortness of breath, chest pains, insomnia, and large swelling of the legs, especially the face. Often takes a forced knee-elbow position. In childhood, smallpox, measles. 20 years old syphilis, in 1919 typhus.

Hyperventilation Syndrome: A Common Problem often Missed

Hyperventilation syndrome is far more common than generally believed, and thus usually unrecognized. It often produces misleading complaints that include alterations of consciousness, inexplicable sensory and motor sensations, and it is often masked by coexisting somatic symptoms such as unusual chest pains. Obscuring recognition further, symptoms attributed to the panic disorder are often, in reality, those of hyperventilation. Proper diagnosis of this breathing disorder depends upon a heightened awareness of its various manifestations, which can then lead to effective means of diagnosis and management

**C252** Chap. 9.

This chapter includes a series of unusual cases from Maine, New Hampshire, Massachusetts, Georgia, London, and Paris. A twenty-five-year-old Maine woman with the usual symptoms of pulmonary consumption developed postpartum chest pains and a swollen leg, was treated, and all symptoms resolved. A twenty-year-old physician from New Hampshire was subject to frequent and profuse hemoptysis, up to a pint of blood at a time. Besides frequent bloodletting to obviate plethora, he conceived of the idea of the efficacy of breast milk. Of every nursing woman whom he met, he solicited permission to draw her breasts. After a year of little or no other nourishment, except cow’s milk when he could not find a supply of breast milk, he had become nearly free from hemoptysis. He died at the age of fifty-seven. An 1822 case of chest surgery and rib-resection for infection in Augusta, Georgia, was reported in the New England Journal of Medicine.

Diagnosis and management of congenital absence of pericardium: a case report

Background Absence of the pericardium is a rare congenital defect with an approximate incidence of <1/10 000. We review a case of complete pericardial agenesis in a symptomatic patient with gross cardiac mobility, for which pericardial reconstruction was undertaken successfully. Case summary A 24-year-old otherwise fit and well patient, with debilitating exertional chest pain was found to have complete pericardial agenesis on the left side and on the diaphragmatic surface. There was gross cardiac mobility demonstrated on cardiac magnetic resonance imaging. His pericardium was reconstructed surgically using Gore-tex® patches. There were no complications, and the patient was discharged 8 days later. Three months later at follow-up, the patient required no analgesia and has had complete resolution of his chest pains. Discussion Congenital hemi-pericardial agenesis is a very rare condition which often remains undetected due to its asymptomatic nature. It is important to consider this as a differential diagnosis of exertional chest pains. Cardiac magnetic resonance imaging remains the investigation of gold standard. There is no consensus on whether surgical intervention in symptomatic or asymptomatic patients has any prognostic value. However, we have demonstrated that by reconstructing the pericardium in a highly symptomatic patient, there has been a resolution in size of a previously dilated right ventricle and most importantly an improvement in quality of life.

Intramural Esophageal Dissection: A Rare Cause of Acute Chest Pain after Percutaneous Coronary Intervention

Intramural esophageal dissection is a condition that typically presents with chest pains and may be associated with hematemesis, odynophagia, and hematemesis. The role of antiplatelet/anticoagulant agents in the development of intramural esophageal hematoma is controversial. The management of intramural esophageal dissection is generally conservative with low mortality and morbidity. The case described here is a 66-year-old woman who presented with chest pains, odynophagia, and dysphagia 1 month after percutaneous coronary intervention while taking ASA (80 mg daily) and clopidogrel (75 mg daily) for dual antiplatelet therapy. The patient was diagnosed as intramural esophageal dissection and underwent successful conservative medical management. The relative contribution of dual antiplatelet therapy with ASA and clopidogrel after percutaneous coronary intervention in this case is, albeit uncertain, a possibility.