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A 'Functional Murmur' and Stroke in a Young Adult

A 'Functional Murmur' and Stroke in a Young Adult Abstract A 19-year-old man had a history of a "functional murmur" since birth and transient episodes of hemiparesis that he had ignored. On Feb 16,1979, he collapsed while playing handball. He was noted to grab his neck and fall, with clonic movements of his extremities. Physical examination disclosed a thin man appearing in distress. His BP was 110/70 mm Hg, his pulse rate was 70 beats per minute and regular, and his respirations were 18/min. Positive physical findings included the cardiac examination where the apical impulse was in the fifth left intercostal space at the midclavicular line. S1 was soft, S2 was persistently split but moved physiologically. A 3/6 mid-frequency systolic ejection-type murmur at the second left intercostal space without radiation, and a 2/6 high-frequency holosystolic murmur at the apex radiating to the left sternal border were noted. The results of a neurologic examination were consistent with a right middle cerebral References 1. Baron MG, Wolf BS, Steinfeld L, et al: Endocardial cushion defects: Specific diagnosis by angiocardiography. Am J Cardiol 1964;13:162-175.Crossref 2. Bedford DE: The anatomical types of atrial septal defect. Am J Cardiol 1960;6:568-574.Crossref 3. Ugarte M, De Salananca FE, Quero M: Endocardial cushion defects: An anatomical study of 54 specimens. Br Heart J 1976;38:674-682.Crossref 4. Bharati S, Lev M: The spectrum of common atrioventricular orifice (canal). Am Heart J 1973;86:553-561.Crossref 5. Craig RJ, Selzer A: Natural history and prognosis of atrial septal defect. Circulation 1968;37:805-815.Crossref 6. Mark H: Natural history of atrial septal defect with criteria for selection for surgery. Am J Cardiol 1963;12:66-74.Crossref 7. Dave KS, Pakrashi BC, Wooler GH, et al: Atrial septal defects in adults. Am J Cardiol 1973;31:7-13.Crossref 8. Dillon JC, Weyman AE, Feigenbaum H, et al: Cross-sectional echocardiographic examination of the interatrial septum. Circulation 1977;55: 115-120.Crossref 9. Williams RG, Rudd M: Echocardiographic features of endocardial cushion defects. Circulation 1977;49:418-422.Crossref 10. Komatsu Y, Nagai Y, Shibuya M, et al: Echocardiographic analysis of intracardiac anatomy in endocardial cushion defect. Am Heart J 1976;91: 210-218.Crossref 11. Sahn J, Terry RW, O'Rourke R, et al: Multiple crystal echocardiographic evaluation of endocardial cushion defect. Circulation 1974;50: 25-32.Crossref 12. Diamond MA, Dillon JC, Haine CL, et al: Echocardiographic features of atrial septal defect. Circulation 1971;43:129-135.Crossref 13. Hanna R: Cerebral abscess and paradoxic emboli associated with congenital heart disease. Am J Dis Child 1941;62:555-567.Crossref 14. Winters WL, Cortes F, McDonough M, et al: Venoarterial shunting from inferior vena cava to left atrium in atrial septal defects with normal right heart pressures. Am J Cardiol 1967;19:293-300.Crossref 15. Maillis MS, Cheng TO, Meyer JF, et al: Cyanosis in patients with atrial septal defect due to systemic venous drainage into the left atrium. Am J Cardiol 1974;33:674-678.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

A 'Functional Murmur' and Stroke in a Young Adult

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350030133021
Publisher site
See Article on Publisher Site

Abstract

Abstract A 19-year-old man had a history of a "functional murmur" since birth and transient episodes of hemiparesis that he had ignored. On Feb 16,1979, he collapsed while playing handball. He was noted to grab his neck and fall, with clonic movements of his extremities. Physical examination disclosed a thin man appearing in distress. His BP was 110/70 mm Hg, his pulse rate was 70 beats per minute and regular, and his respirations were 18/min. Positive physical findings included the cardiac examination where the apical impulse was in the fifth left intercostal space at the midclavicular line. S1 was soft, S2 was persistently split but moved physiologically. A 3/6 mid-frequency systolic ejection-type murmur at the second left intercostal space without radiation, and a 2/6 high-frequency holosystolic murmur at the apex radiating to the left sternal border were noted. The results of a neurologic examination were consistent with a right middle cerebral References 1. Baron MG, Wolf BS, Steinfeld L, et al: Endocardial cushion defects: Specific diagnosis by angiocardiography. Am J Cardiol 1964;13:162-175.Crossref 2. Bedford DE: The anatomical types of atrial septal defect. Am J Cardiol 1960;6:568-574.Crossref 3. Ugarte M, De Salananca FE, Quero M: Endocardial cushion defects: An anatomical study of 54 specimens. Br Heart J 1976;38:674-682.Crossref 4. Bharati S, Lev M: The spectrum of common atrioventricular orifice (canal). Am Heart J 1973;86:553-561.Crossref 5. Craig RJ, Selzer A: Natural history and prognosis of atrial septal defect. Circulation 1968;37:805-815.Crossref 6. Mark H: Natural history of atrial septal defect with criteria for selection for surgery. Am J Cardiol 1963;12:66-74.Crossref 7. Dave KS, Pakrashi BC, Wooler GH, et al: Atrial septal defects in adults. Am J Cardiol 1973;31:7-13.Crossref 8. Dillon JC, Weyman AE, Feigenbaum H, et al: Cross-sectional echocardiographic examination of the interatrial septum. Circulation 1977;55: 115-120.Crossref 9. Williams RG, Rudd M: Echocardiographic features of endocardial cushion defects. Circulation 1977;49:418-422.Crossref 10. Komatsu Y, Nagai Y, Shibuya M, et al: Echocardiographic analysis of intracardiac anatomy in endocardial cushion defect. Am Heart J 1976;91: 210-218.Crossref 11. Sahn J, Terry RW, O'Rourke R, et al: Multiple crystal echocardiographic evaluation of endocardial cushion defect. Circulation 1974;50: 25-32.Crossref 12. Diamond MA, Dillon JC, Haine CL, et al: Echocardiographic features of atrial septal defect. Circulation 1971;43:129-135.Crossref 13. Hanna R: Cerebral abscess and paradoxic emboli associated with congenital heart disease. Am J Dis Child 1941;62:555-567.Crossref 14. Winters WL, Cortes F, McDonough M, et al: Venoarterial shunting from inferior vena cava to left atrium in atrial septal defects with normal right heart pressures. Am J Cardiol 1967;19:293-300.Crossref 15. Maillis MS, Cheng TO, Meyer JF, et al: Cyanosis in patients with atrial septal defect due to systemic venous drainage into the left atrium. Am J Cardiol 1974;33:674-678.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1983

References