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.
53/80 page 355
![A portion of the curve, is reproduced in Fig. 9. To the left is tlie fibrillation ])eriod, and to the right are a few heats of the paroxysm for comparison. The original curve is too faint for jniblication, hut the two .sections of curve have been traced by a skilled draughtsman and the original is well ])ortrayed. A stop and two inches of curve have been excised at the jioint where the vertical line is placed. The change from one mechanism to the other was not recorded. Fig. 9. H. B. (12th .Aug. 1909). From a ca.se fully recorded in tlie la.st number of this Journal (page 2(52). The original curve ha.s been retraced, and two inches of curve have been excised. To the left the electrocardiogra])h .shows auricular fibrillation. To the right is a paroxysm of regidar tach}’cardia, starting, not at the sinus, but in the auricidar walls. This fact is recogni.sed because the auricular \ ariations are absent ii\ their usual form. The peaks R of this |)aroxysm are not longer than those of the ])receding fibrillation ])eriod, yet the,\’ were always longer than the peaks R of the normal rhythm when the two could be compared. The comparison is utilised as evidence that the peaks R of fibrillation are higher than those of the normal rhythm. Now' in the case of regular auricular jtaroxysmal tachycardia Ihc actual ))aro.xysms arc usually if not always foreshadowed by the occurrence of single or multiple ectojiic beats of a different kind. This has been observed invariably in the paroxysms of two cases of auricular tachycardia {Heart I, p. 2(12 and CASE la, with Fig. 2(5 of this paper). And I have advanced the view that the preliminary Ixuits stand in casual nfiationshij) to the paroxysn.s themselves. If single (tr midtiple beats arising in the auricle may pre- dispose to the ))roduction of a ]taroxysm of regular beats also arising in the auricle, may not thc.s{‘ beats also account in part for the on.set of an attack of fibrillation ? 'Phe (piestion arises as to whether a beat arising de novo in a chamber of the heart and pursuing an abnormal course in this chamber will enhance the irritaltility of the musculature in the immediate neighbourhood. Sup|)osing that two or more extra- systoles are started at the same time at different |)oints in the muscidatur(‘ of an irritable auricle, are not those factors present which ar(‘ calculated to produce a condition of absolute inco-ordination ? The evidence is at present only suggestive; long p aroxysms ot rapidly recurring beats are apj)arently provoked by other beats of a similar nature,](https://iiif.wellcomecollection.org/image/b29000610_0053.jp2/full/800%2C/0/default.jpg)
