Fig. l.-Electrocardiogram inversion of R: bte 112: tri cular preponderance.
all complexes Lead IVF
Fig. 2.-Electrocardiogram all waves Bositive in Lead all complexes upright with preponderance.
of Lead large
dextrocardia in Lead shows all
dextrocardia II is the S wave.
showing I, normal complexes
the three standard complexes in Lead inverted.
after interchanging same as Lead III This electrocardiogram
arm wires; rate 92; 1. Lead IVF shows shows left ventricular
A case of angina pectoris with pain radiating to the right in an individual with dextrocardia with situs inversus.
arm is reported
RE,FEZREX:(:EB Complete Transposition of the Viscera. -Y Report 1. T,e Wald, I,. T.: Cases With Remarks on Etiology, J. A. h1. A. 84: ?dl 195. Cougcnital Destrocardin With Situ; Transversus ‘2. W’illius, Frederick A.: Hypertenaivc Heart Disease; Electrocardiographic Changes, AM.
HEART J. 7: 1,
1931. Coronary Thrombosis in a Case of J. Hamilton, and Warren, Charles Ford: Congenital Dextrocardia With Situs Inversus, AM. HEART J. 15: 240, 1938. Dextrocardia With Situs Inversus Compli1. Manchester, Benjamin, and White, Paul D.: cated by Hypertensive and Corqnarp Heart Disease. dnc. HEART J. 15: 493, 1938. 2. Crawford,
ARMY OF THE VXITED
T IS well known that auriculoventricular heart block may occur during the course of acute infections. Its frequency in rheumatic fever is generally recognized. It has been reported in such inEect,ions as diphtheria’ influenza,” typhoid fever,3 pneumonia, scarlet fever, and typhus fever.” Textbooks” mention endocarditis as a rare complication of German measles, and pericarditis, myocarditis, and endocarditis as complications of measles. The occurrence of heart. block in German measles has not been reported so far as wc are able to determine from a review of the lit.erature of the past twenty-six YeiIrs. The rarity of this condition prompts t,he present report.
A private, aged 23 years, was admitted to the hospital on i%rch 24, 1943, complaining of sore throat and glandular swelling in the neck which had been present for three‘ days. The past history revealed an attack of mumps Iloring childhood. There wax no history of rheumatic fever or chorea. Physical examination showed a moderate pharyngitis with swelling of the posterial cervical glands, most marked on the left side. The heart was of normal size. No murmurs were heard. The rhythm was regular. The blood pressme was 110/68. The examination otherwise was essentially normal. Laboratory examination revealed 23,100 white blood cells with a normal differential count. The Wassermann and Kahn reactions of the blood were negative. Four days after admission there were 18,000 white blood cells with 78 per cent polymorphonuclear leucocytes, 15 per cent lymphocytes, and 7 per cent mouocytew. During the first two weeks in the hospital the temperature ranged from 100" F. to 101” F. and then returned to normal. Five days after admission the patient was given 32 Gtn. of sulfadiazine extending over a period of four clays without apparent beneficial effects. On the ninth hospital day the patient became dizzy and almost fainted in the lavatory. The pulse rate was 36. An electrocardiogram taken at this time revealed cotnplete heart block (Fig. 1). A blood count showed 11,550 white blood cells with a normal differential count. On the tenth hospital day the pulse rate was 80, and partial heart block was present with a three-to-two rhythm (Fig. 2, a). Atropine sulfate, 0.00096 Gm., was given intravenously with an immediate decrease in the Received