A historic instance of the Adams-Stokes Syndrome due to heart-block / by G. A. Gibson and W. T. Ritchie.

Date:
1909
Catalogue details

Licence: In copyright

Credit: A historic instance of the Adams-Stokes Syndrome due to heart-block / by G. A. Gibson and W. T. Ritchie. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    the block became permanently complete, there was an organic lesion of the auriculo-ventricular bundle, leading eventually to complete failure on the part of the bundle to conduct the physiological stimuli to the ventricles. As the tracings show complete auriculo-ventricular dissociation, it is to be expected that, just as the auricular and carotid waves sometimes coincide, so will the auricular and ventricular waves occasionally occur simultaneously, and we find it so. At times the ventricular wave appears quite distinct and apart from any other wave—for example, the ventricular wave between the eleventh and twelfth auricular waves in Plate II., or that between the twenty-first and twenty-second auricular waves in Plate III. But at other times the ventricular wave does coincide with an auricular one. The third auricular wave in Plate I. and the Fio. 3.—Tracings from the apex beat and radial pulse. eighteenth auricular wave in Plate III. may be referred to in illustration of this fact. As the occurrence of a ventricular wave indicates an ante- cedent contraction of the right ventricle, the tracings prove that the two ventricles beat synchronously, rhythmically, and at the same infrequent rate. The records of the movements of the left i auricle are less clear than those of the right. We have elsewhere ^ s shown records of heart-block in which large positive waves, pro- ; duced by the systolic movements of the left auricle, appeared in the apical tracings. But even if we were unaware of the fact ; that when there is a condition of complete auriculo-ventricular heart-block the two auricles always continue to beat in unison, ‘ we should find, in Pig. 3, sufficient evidence that in the present instance the left auricle was beating at a rate and with a rhythm •wholly independent of the left ventricle. In the upper tracing ’ 3, taken from the apex beat, there are a number of small ] foceedimjg of the Royal Society of Edinburgh, 1905, vol. xxv. j). 1085; ' oritwh Mediad Journal, 1900, vol. ii. p. 1113.
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