Patient 1:

This is a young man with intravenous drug use who was admitted to the hospital with infective endocarditis of the aortic valve resulting in severe aortic regurgitation. He was observed to have myokymia of the chest wall in rhythm with the cardiac cycle. We have hypothesized that the myokymia resulted from mechanical irritation to the chest wall muscles during ventricular systole.

This patient also has an Austin Flint murmur over the apex.