Lorna Medd, MD, Junior Assistant Resident in Medicine, The Jewish Hospital of St. Louis and Assistant in Medicine, Washington University School of Medicine: A 64-year-old white man was admitted for the first time to Jewish Hospital on Nov 22, 1971. He had been involved in a minor car accident the morning of admission. Immediately after the collision, the patient suffered crushing, nonradiating, substernal pain associated with dyspnea. He had had several episodes of similar pain, especially when walking in cold weather. In 1968, he was hospitalized in the medical center for acute pulmonary edema. He responded well to digitalization and diuresis and subsequently received digitalis and a thiazide diuretic. There was no myocardial infarction documented at that time. There was no personal or family history of gout.
Physical examination showed moderate obesity, a blood pressure of 180/90 mm Hg, slight cardiomegaly with an increased aortic second sound, and a grade