A 67-year-old man was seen on March 21, 1984, with the complaint of aching of the left side of his chest. He had suffered an anterior myocardial infarction in 1981 and underwent coronary bypass surgery and resection of a left ventricular apical aneurysm in March 1983 after a two-month history of accelerated angina pectoris. He was feeling well until September 1983, when he developed recurrent prolonged episodes of hiccups and a dry cough. In February 1984 he was treated at a local hospital for pneumonia. A chest roentgenogram taken at that time was reported to be suggestive of a ventricular aneurysm.
Physical examination revealed a prominent and diffuse left ventricular lift, a blowing grade 2/6 apical systolic murmur that radiated to the lower left sternal border and axilla, and a loud two-component friction rub over the entire precordium. An electrocardiogram showed sinus rhythm, small R waves in V1 to V