LAUSR

A 56-year-old woman had a history of acute rheumatic fever with polyarthritis at age 6 years. She had been seen intermittently as an outpatient at our hospital over the past 6 years with systemic arterial hypertension, obesity, adult-onset diabetes mellitus, and peptic ulcer disease. All of her electrocardiograms over that period showed left atrial enlargement, and many had large QRS voltage consistent with left ventricular enlargement. She was never told of rheumatic heart disease. On the day of admission, she came to the emergency department with the new onset of palpitations, diaphoresis, and dyspnea. An electrocardiogram showed atrial fl utter/ fi brillation with an irregular ventricular response at 156 beats/minute, Ashman’s phenomenon, and nonspecifi c ST-T changes (Figure). From the Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana.