This study was undertaken after an examination made two years ago upon a Mexican male, aged forty-nine, with a to-and-fro murmur. The blood pressure was 90/60 and therefore not characteristic of aortic leak. Ascites existed, but no edema of the extremities. Strangely, no orthopnea was apparent, and the degree of prostration, anemia, and stupor was far greater than is commonly seen in heart disease. In fact, so prominent were the heart symptoms that definite evidence of pulmonary metastases in the x-ray plates were seriously questioned. Impaired resonance and absence of breath sounds prompted us to remove 3550 c.c. of blood-tinged fluid from the right thorax. The ascites masked the presence of any abnormality. Case Report The patient entered the Los Angeles General Hospital on March 5, 1934, complaining of shortness of breath, gas on the stomach, and weakness. He stated that he had been in good health up to seven months previously, when he began to suffer from indigestion, manifested by a sense of pressure and a dull, heavy sensation in the abdomen. Shortness of breath was first noticed three months before admission and along with weakness had become progressively worse. Otherwise the history was not significant. There was no cough or expectoration. There was no history of syphilis or rheumatism. On examination, the man did not appear dyspneic; he lay flat in bed without discomfort, but was very weak. The body tissues were of good tone and there was no edema. The sclerae were not icteric and the pupils reacted to light and accommodation. The blood pressure was 90/60. Examination of the chest showed the heart well over to the left. The rate was regular but rapid, 100–120 beats per minute. A double rough murmur was audible at the third interspace to the left of the sternum. Coarse râles were audible in the left base; the right chest and axilla over the lower two-thirds were fiat and without sound, suggesting the presence of fluid and displacement of the heart to the opposite side. No abnormalities were discovered in the abdomen or extremities; no masses were palpated, and there seemed to be no enlargement or tenderness over the liver edge.