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.
57/80 page 359
!['I’he secoiul type of case is that of a not uncoininon form of paroxysmal tachycardia.* 1 have met with three cases of a similar if not identical natuie during the last six months. In one case mitral stenosis was found ; in the other two no physical signs weie apj)arent in the heart exc(‘pt during the paioxysms. 'I'he paroxysms were associated in the last two cases with slight hut progi-essive dilatation, and the throbbing in the veins of the neck was sufficiently forcible to suggest arterial ])ulsation. Tracings are given from one of these patients in Fig. 1 \<( and h. Fig. I lu w as obtained l)et ween two paroxysms ; Fig. 1 15 during a j)aroxysm. In the first curve the venous [)ulse is of the auricular and in the sect)nd of the ventricular form. V VV V y *V ¥ » 'V V V 11^ 111^ » »**> /r Fi;r. I l« iwitl h. 'two |M)lygra|)li tracings 11(1111 a |)atieiif «itli paroxysmal taclucarclia. 'I’laciiig a i.s normal. Tracing h shows the venous pulsc> to he of the \ ('ntrieular form while the paro.xysm is in progress. The putse is regular in both curves. Ill both curves the arterial pulse is regular, the respective rates are !)2 and 147. In the absence of electrocardiographic curves it is impossible to ascertain the nature of the mechanism. It may be of a kind suggested by Wenckebach”'*, for it is possible that with an increased As-\'s interval the auricular contraction falls back on the preceding ventricular systole. In the case of mitral stenosis, previously referred to, this explanation w ould suffice, for a prolongation of the a-c and F-R intervals was present while the pulse * tvrtain regular i)aroxysms actx)ni])auiecl hy tho ventricular form of venous pulse and descrihed by Mackenzie'’'' and Hewlett'-may bo included in this group.](https://iiif.wellcomecollection.org/image/b29000610_0057.jp2/full/800%2C/0/default.jpg)
