Case Study

A female patient aged 44 was affected by severe mitral stenosis. This was confirmed by Doppler test, the valve area being less than 1 cm2; the pressure gradient was 18 mmHg and moderate pulmonary hypertension was therefore presumable. The patient often suffered quickly from fatigue when doing housework and going upstairs and she had been admitted to hospital for lung edema 3 weeks previously. When I performed PPT on her auricles for the first time I found two tender points on the left concha and one on the right concha, presumably related to her previous heart failure and lung edema (Fig. 5.40, red points).

After 3 months she underwent mitral commisurotomy; 1 year later the result was still considered acceptable as the valve area was rated 2.2 cm2 with only very limited regurgitation evidenced at the Doppler control test. The patient nevertheless complained of dyspnea on making slight efforts and an ECG recorded atrial fibrillation with high ventricular frequency. On this occasion I had the opportunity of checking the patient's auricles again: the tender point on the right auricle had disappeared whereas the left concha still had two tender points but in a different position: one was shifted further upwards to the 'basic zone for heart and coronary circulation' (area 1); the other was shifted backwards toward Durinyan's area 3 shown in Figure 5.39 (Fig. 5.40, gray points).

Fig. 5.39 Representation of the cardiovascular system according to Durinyan.

(red); the same patient 1 year after surgery (gray).

results. Checking the patient's auricles again I found a very sensitive point close to Durinyan's 'basic zone for heart and coronary circulation' (Fig. 5.41, gray point). An ECG was repeated (1 month after the first) and this time signs of inferior necrosis were evident, even though myocardial enzymes were negative. The Bruce stress test with increasing loads confirmed signs of transmural ischemia with ST-segment elevation in D2, D3 and aVF until the seventh minute of recovery. Medication based on nitrates, calcioantagonists and heparin eliminated the neck pain as well and I could not find any of the tender points on the anthelix identified during the first examination.

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