WHIPPLES-DISEASE AND THE HEART

A 50-year-old man with Whipple's disease was found to have a positive Kussmaul's sign, prominent jugular V waves and a pansystolic murmur. E chocardiography revealed severe tricuspid regurgitation and moderate a ortic and mitral regurgitation. Thickening of the noncoronary aortic c usp, calcification of the mitral annulus and a possible calcified dens ity embedded in the left ventricular free wall mere also noted. A revi ew of the literature demonstrates high prevalence of cardiac manifesta tions in patients with Whipple's disease. Constrictive pericarditis, v alvular deformity, myocarditis, coronary arteritis, congestive heart f ailure and sudden death have been documented. No clear relationship be tween the extent of cardiac involvement and the severity of the system ic disease has been shown, and the efficacy of antibiotic treatment fo r cardiac lesions remains to be demonstrated.