Exceptional types of slow heart action / by Thomas Lewis.

  • Thomas Lewis
Date:
[1913]
Catalogue details

Licence: Public Domain Mark

Credit: Exceptional types of slow heart action / by Thomas Lewis. Source: Wellcome Collection.

    4/22 page 222
    minutes after the injection by an acceleration of heart-rate. At the same time the patient complained of a dry feeling in the throat. The greatest acceleration was to 62 beats per minute, and within two hours of the injection it had almost returned to its original slow rate (48 per minute). The heart maintained this low speed of contraction during the three months he was in hospital. The evening rate was usually somewhat faster than that of the morning. On May 2 he was allowed to walk down four flights of stairs, spend a half-hour in the grounds, and return to the wards. On this evening the pulse-rate was 56 per minute, and each day it was observed that similar exertion produced the same effect. The fastest rate thus observed was 64 per minute, except on a solitary occasion (May 16), when a rate of 80 per minute was attained. The general physical signs remained unaltered, but the exercise produced a certain amount of dyspnoea. No drug of the digitalis group was given at any time during his stay in hospital. To sum up, while the usual pulse-rate was 40-48 per minute, after a period of three months, the period of observation, it not infrequently fell below these rates: the lowest rate reached was 26. Rates of over 48 were only observed after atropin injection and exercise. For the clinical notes of this case and the observations upon the action of atropin I am indebted to Dr. Agassiz, resident medical officer at the City of London Hospital. Graphic records. In most of the polygraphic curves taken from this patient each arterial pulse-beat was accompanied by a venous wave of the plateau form, the latter being regularly preceded by a single a wave (Fig. 1). The correspond- ing electro-cardiographic curves showed a normal sequence and normal P sum- mits. The slow heart action was therefore usually of uncomplicated sinus origin (Fig. 11). The slow rhythm, as has been stated, was usually fairly regular, but from time to time irregularity occurred, Under these circumstances the irregu- larity, as portrayed by the venous and electro-cardiographic curves, was also of sinus origin (Figs. 1 and 11); the irregularity was parallel in auricle and ven- tricle ; each ventricular summit, wherever placed, was preceded by an auricular summit of constant form. Here and there in the polygraphic curves the
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