To the Editor.—
Forbes and Bradley1 reviewed evidence supporting a relationship between chronic hypoxia and increased cardiac muscle mass, and suggested that some cases of cardiomyopathy are caused by abnormalities of coronary arteries. The case reported here supports that view.
Report of a Case.—
A 31-year-old woman died suddenly on the street. She had suffered painless heart disease of four years' duration, characterized by cardiac enlargement, palpitations, low blood pressure, and congestive failure. Abnormal autopsy findings were limited to the heart, which weighed 0.32 kg and showed biventricular dilatation. The valves were normal. The coronary ostia and main coronary arteries were extremely small, and the secondary arterial lumens were almost invisible to the unaided eye. Muscle fibers in both ventricles were hypertrophied and many fibers of the free wall of the left ventricle had been replaced by collagen, which in many areas surrounded isolated, hypertrophied muscle cells. The same