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.
56/80 page 358
![demonstrated that aiirieidar inco-ordination may he ])resent, and yet the pulse regular. But there are at least two tyi)es of ease in which, whde there is no venous sign of auricular contraction and the ))ulse is regulai, aiuiculai inco-ordination is certainly or jjrohably absent. Such being tbe case, an opinion that auricular fibrillation exists is not justified, where the pulse is regular, in the absence of electrocardiogra})hic records. The first type is that in which the pulse rate is usually of normal or but slightly increased rate, ddie patients are not infiecjuently encountered, and offer signs of dilatation of the right heart with considerable distension of the veins. An example of a ]mlygra])h tracing is shown in Fig. 10, Fiji. 10. Tlip \ontric'ulai’ form of venous ]uilse in a pationt with regular aetion of the heart. .Auricular fihrillation was not present {CASE 14). CAS E 14.—F. W., a girl aged 12, had .sufTered from three attacks of rheumatic fever, and there was a clear liistory of peric-arditis. 'the sympton\s consisted of sc\'ere shortness of lacath. cough and |)ain in the chest and u))per ahdoiuen. On examination the veins were seen to Ix' gnuitly distended and th(' tension in tlaun was increased. 'I'lu' pulse was regular and “ watei- hammer in character, capillary pulsation was |)r('sent. 'The li\er was ('nlargml and ))ulsatil('. di'opsy of th(> feet and ascites were found. 'l’h(> right limit of cardiac duhu'.ss was 2 inches and the left 0 inches from the michsternal line. I’herc was definite post-sternal dulness on a le\'el with the second and third rihs. 'I'h(> lungs faiU'd to cover the heart during deej) ins))iration and the heart’s apt'x was fixed. ,\n early diastolic murmur was a\idihle o\’<'i' the grc'ater part of the precordium. being maximal at the aoitic cartilagf'. An occasional faint presystolio murmur ami a constant systolic murmur were heard at the apex. Aortic regurgitation, mitriil stenosis and |)leuro-i)eriear(lial itdlu'sions, ])robably extending to the tuediastinum, were diagnosed. The ])ulse was invariably regular, the jugular curves failed at almost all times to show any trace of jtresytolic elevation. In the tracing givtm (Fig. 10) a very faint trace of a wave is visible, but it was never more marked than here (h'pieted, iind usually eould not be obtained. The electrocardiogram demonstrattal a clear F variation (Fig. 25). Tlu' cti.se is an ('xamph' of the ventricular form of venous pulse aceom|)anying the normal secpiential chand)er con- traction. (Similar eases have been reported by llering’ and Hewlett-'.)](https://iiif.wellcomecollection.org/image/b29000610_0056.jp2/full/800%2C/0/default.jpg)
