Auricular fibrillation and its relationship to clinical irregularity of the heart / by Thomas Lewis.
- Thomas Lewis
- Date:
- [1910?]
Licence: In copyright
Credit: Auricular fibrillation and its relationship to clinical irregularity of the heart / by Thomas Lewis. Source: Wellcome Collection.
49/80 page 351
![12.—Tlio followiiip is nn al)straf't of tlic original roport ( Heart, Vol. T, j). 2r>).— W. II.. a subject of rheiiniatic fever, was known to liave had im|mirment of conduction in greater or los.ser degree for 12 years. He then suddenly developed slow anil irregular action of the heart and demonstrated the ventricular form of venous pidse. In this state he continued a week, at the end of which time the pulse was again regidar and the a-c interval was 0-4 sec. in length*. Se%’en months later the same slow and irregular action of the heart was resumed and it has persisted until the present time, a period of five years. A tracing from this patient is given in Fig. 4 A. On the day upon which he came for re-examination the pulse rate was 411-68. The ])ulse was absolutely irregular, the venous curve being of the ventricular form. There were fibrillation waves in the curves. In Fig. 10 simultaneous electro- cardiographic and venous curves are shown. The electrocardiographic record is characteristic and the usual oscillations are jtresent. There can be no (piestion but that the case is one of auricular fibrillation. The long-continued history of heart-block previous to the onset of the irregularity and its ])resence during a brief interlude strongly sujiports the view that the slow ventricular rhythm resulted from the known inefficiency of the junctional tissues which transmit the irregular imjmlses formed in the auricle. CASE 13. — M. ]\I., ago 45 (extract from Heart, Vol. i, p. 35).—“ Permanent nodal rli3'thm, bradvcardia associated with mitral stenosis. Occasional attacks of svncope and convulsions.” Recently the ca.se has been fully re-investigated, and a detailed report of it will be found in the contemporary number of the Quarterly Journal of Medicine. The main facts in regard to the patient are as follows :—Apart from the e])ileptic seizures the pulse rate is almost constantly ut or about 30 per minute. This is the rate generally assumed by the ventricle when it is entirely dissociated from the auricle. As in comjilete heart-block the ])ulse is regular. The jiatient has synco))al and epilej)tic attacks in every way similar to those met with in the subjects of com])lpte heart-block. Extrasystoles, when they occur, are followed by ])auses etpial to the spaces between adjacent beats of the usual slow rhythm. The ])atient has had .syphilis. Ih’iefly, the |)atient ])resents a ])icture identical with that of complete heart-block, as usually recognised, in every respect but one. There are no co-ordinate* auriculai’ contractions. The venous judsc is of the ventricular form and (‘lectroeardiograms from the extremities and chest wall (Fig. 18 and exj)lanation) afford clear (‘vidence that the auricles are fibrillating. 'I'he conclusion is unavoidable that the case is one of complete heait- block (the result of syphilis) and auricular fibrillation. The regularity of tl c pulse is a natural consequence of the inability of the auricular in pulses If reach the ventricle. Fredericq” has shown experimentally that section of ll.( bundle, while the auricle is fibrillating, cuts off all auricular impulses. Dr. (libson, of Edinburgh, has drawn my attention to a case, of con- siderable interest in this connection, which he reported in 1606. The tracings * The normal a-f interval i.s 0-2 .sec. or slightly less.](https://iiif.wellcomecollection.org/image/b29000610_0049.jp2/full/800%2C/0/default.jpg)
