Medicine Resident, The Jewish Hospital of St Louis, St Louis: The patient was admitted on Thanksgiving day in 1973 for the second time to The Jewish Hospital with a chief complaint of chest pain. He was known to have Marfan's disease and was initially admitted to Jewish Hospital in 1971 for an evaluation of an enlarged heart and cardiac murmurs. At that time coronary angiography and cardiac catheterization showed mitral insufficiency with prolapse of the mitral valve.
On the morning of his second admission the patient experienced continuous, severe, sharp, midline chest pains during intercourse with radiation to the jaws, attended by nausea, vomiting, and diaphoresis. At the time of admission he was taking digoxin, 0.2 mg daily, for chronic atrial fibrillation. Family history showed that his father had had Marfan's disease and died in his 40s of an aortic dissection. A sister had Marfan's disease and a brother died