The importance of the electrocardiogram in the diagnosis of pulmonary embolism was first demonstrated by McGinn and White (1935) but general opinion still varies concerning the precise diagnostic value of this method of investigation. As recently as 1952 Newman stated that in only 10-20 per cent of cases of pulmonary embolism is there a characteristic pattern and that electro--cardiographic examination is not a good method of making the diagnosis. By contrast, Phillips and Levine (1950) are of the opinion that the diagnosis of pulmonary embolism can be made with a high degree of accuracy and, indeed, that the first clue to the diagnosis may often be found by this method.The object of this paper is to analyse in detail the electrocardiograms of 50 undoubted cases of pulmonary embolism and to compare these results with those of other workers in order to assess its value in making the diagnosis. In addition, an attempt is made to correlate the severity of the clinical picture with the electrocardiogram, and also to show how the presence or absence of pulmonary infarction affects it. MATERIAL AND METHOD OF SELECTIONThe material was obtained from the records of four hospitals. About a quarter of the cases were seen personally by one of us within 24 hours of the time at which the embolism occurred. All patients had at least one 12-lead electrocardiogram (the three standard leads, the three unipolar limb leads, and six chest leads, VI-6) taken after the embolism and in 25 instances serial records were obtained.In a study of this kind there are two practical difficulties in obtaining suitable material. The first is to obtain records from patients in whom there is no doubt whatsoever concerning the certainty of the diagnosis. This is discussed below and our diagnostic criteria are given. The second difficulty is that those patients who die very soon after the onset of the embolism frequently do so before there is time for an electrocardiogram to be taken. In this series of 50 patients there are 11 in whom the diagnosis was verified after death. The post-mortem examinations revealed that the coronary arteries were patent in all except Case 43, and this case is discussed separately.Details of the 11 cases that came to autopsy can be seen in Table I.In addition to the autopsied cases we studied 83 other patients in whom a clinical diagnosis of pulmonary embolism had been made but we discarded 44 of these because, in our opinion, the clinical picture was not certain enough to put the diagnosis beyond all doubt. The remaining 39 patients were considered by us to be undoubted examples of pulmonary embolism, our criteria being as follows.Twenty-one suffered a sudden attack of pleuritic pain followed in a few days by hrmoptysis. This attack occurred either within 14 days of a surgical operation or in the presence of a recent venous thrombosis. In none of them did we find any cause other than pulmonary embolism that could explain the clinical picture. In addition, every patient in this group had either 41 on 12 May 2018 by guest....

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Two cases of constrictive pericarditis with intrapericardial cyst formation are presented. In each, a tricuspid diastolic murmur was present, and confirmation of a tricuspid valve gradient was obtained at cardiac catheterization. Angiographic studies revealed that the tricuspid valves were distorted by the cysts. In both patients, surgical excision was successfully achieved.In case 1 a blood-containing cyst was found, the etiology of which is obscure. Case 2 was associated with rheumatoid arthritis, and the compression resulted from a chronic abscess that probably arose at a previous pericardiectomy. CONSTRICTIVE PERICARDITIS is an uncommon disorder with a wide varietv of manifestations. This communication documents two patients who presented with features of a cardiac murmur indicative of tricuspid valve stenosis. In both, exploratory surgery revealed a large cyst within scarred pericardium, narrowing the tricuspid valve. The first patient had generalized constrictive pericarditis. The second patient had undergone pericardiectomy 16 years previously for constrictive pericarditis.

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