Auricular fibrillation and its relationship to clinical irregularity of the heart / by Thomas Lewis.

  • Thomas Lewis
Date:
[1910?]
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Licence: In copyright

Credit: Auricular fibrillation and its relationship to clinical irregularity of the heart / by Thomas Lewis. Source: Wellcome Collection.

    26/80 (page 328)
    found in two cases in wliich a comparison of the normal and abnormal mechanisms in the same sid)ject was secured*. CASE 10.—G. P., agod 77, was admitted under the care of Dr. IMackenzio, to whom I am indebted for oi)i)ortunitio.s of examining him, in September, 1900. There was no history of past illness, and rhemnatism and ehorea were unknown in the fannlJ^ Ho complained of shglit cough and expectoration, and huskiness of voice of four months’ duration. Anginal symptoms had been present. There had been no shortness of breath, paliiitation, giddiness or dysphagia. Condition, 22-10-09.—A strongly built man ; the face weather-beaten. The voice is husky, laryngeal examination shows abductor ])aralysi.s. A slight grade of evanosis is present, dhe arteries are thickened, the jndse is completely irn^gular ; the venous jiulse i.s of the \entiicular form. The heart’s apex is obscured by emphysema. The right line of dulness is J incli and the left :H inches from the middle line. There is an area of dulness extending into the second left space and at this point systolic imlsation was present upon admission. But for the irregularity the heart soimds are normal. The urine is normal. The case may be summed up as probably one of aneurism of the thoracic aorta, associated with angina and complete irregularity of the heart. Sub- sequent to his admission he has had many anginal attacks, some of a severe grade. There have been times w hen the pulse is slow, and on such occasions it is regular and the venous pulse has been of the auricular form, and times wdien it is fast and irregular, the venous pulse being then ventricular in outline. The paroxysms of irregularity have been numerous, and they have generally lasted for 24 hours or more. On several occasions the pulse has been irregular for several days together. On the other hand attacks of comparatively short duration have occurred. There have been no definite symptoms at the onset or offset of attacks, and the patient has been unaware of the abnormal cardiac mechanism when it has been present. The anginal attacks have had no relation to the ])eriods of irregularity. dhvo of the curves (Figs. 15 and IG) obtained from this patient were taken within 48 hours of each other. Upon the day when the first electrocardiogram was obtained ])olygraph curves showed the ])resence of complete irregularity and the ventricular form of venous pulse. The electric curve corresponding (Fig. 15) is of the form which Ave have been considering. The peaks R are se])arated by stretches of curve of an irregular character. No two pieces are alike, and the T variations are obscured by the oscillations which are present. Two days later the pidse was regular and the jugular curve demonstrated a ])i ominent (i w a\ e. I he corresponding electrocardiogram is given in Fig. 16 In it the disaiipearancc of the oscillations is associated with the return of the auricular variation P, while the remainder of the ventricular curve is of a ])erfectly normal type. Curves showing the normal rhythm within half an linin' ot the cessation of an attack have since been obtained from this ,.a lent 1 hey Mere of a perfectly normal tyjte. Digitalis, given in doses suHieient to produce toxic eftects, had no retarding influence during the periods of irregular tachycardia. ^ ♦ A tliinl caso will b,> ftniiul in a later seelitm aiul the curves are illustrated by Fig. 9.