Case 1
A 66-year-old man complained of severe headache in 1978.
Temporal arteries were nontender on examination. Westergren sedimentation rate was elevated to 77 mm/h. Left temporal artery biopsy specimen showed irregular intimal thickening with focal disruption of internal elastic lamina and clusters of giant cells at the adventitia. Temporal arteritis was diagnosed. Cardiac examination at that time revealed no diastolic murmur. A chest roentgenogram and electrocardiogram were normal. Therapy was initiated with prednisone, 40 mg each day, and was continued for ten months.
The patient did well until 1982 when he was admitted to the hospital for fatigability; weakness, and syncope. Physical examination revealed a rapid carotid upstroke with bisferious pulse. Bl<x>d pressure was 160/80 mm Hg in both arms. Apex impulse was displaced to the left axillary line. A grade 2/6 systolic murmur was present at the high right sternal border. A grade 3/6 aortic insufficiency murmur was heard at the high right and lower right sternal borders. An Austin Flint nimble with an S;1 gallop was present at apex. A chest roentgenogram at this time showed the development of cardiomegaly with markedly dilated ascending aorta. Electrocardiogram documented left ventricular hypertrophy with ST-T changes.