IN THE PAST 10 YEARS, four consecutive cases of diaphragmatic flutter which were observed in the Maimonides Hospital were associated with rheumatic heart disease. Two of the cases were reported in 19541; two others which were observed recently are the subject of this report.
Report of Cases
A 51-year-old male was admitted on Nov 9, 1962, because of fever, weakness, and palpitation. He gave no history of rheumatic fever or chorea, but said that a heart murmur had been noticed at an early age. Rheumatic heart disease with aortic regurgitation and stenosis had been diagnosed. For the past 20 years the patient had suffered attacks of paroxysmal tachycardia which were usually terminated by pressure on the carotid sinus. He also had experienced prolonged episodes of "hiccoughs" for more than 20 years. These episodes became more frequent and prolonged 2 years ago when the patient became impotent. "Hiccoughing"