Arhythmia of the heart : a physiological and clinical study / by K. F. Wenkebach ; translated by Thos. Snowball.

  • Wenkebach, Karel Frederik, 1864-1940.
Date:
1904
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Licence: Public Domain Mark

Credit: Arhythmia of the heart : a physiological and clinical study / by K. F. Wenkebach ; translated by Thos. Snowball. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    cular concentration of the blood. I am not averse to the use of Lommel's expression relatively too great resistance, but I think it is more likely to further our knowledge in this direction if we recognise that we do not yet know the connection between these phenomena, and that we must wait for further experimental work to elucidate it; in the meantime, we can collect clinical material to help us in solving this problem. This third class may, perhaps, also include those cases where extra-systoles occur on altering the position of the body. We have already heard of cases in which there were no extra-systoles on sitting or standing, but whenever the patient lay down they appeared (§ 22). This phenomenon may be partly due to the slower rate of the heart on lying down. But it is often so well marked, even on the patient's changing from his back to his side, and vice versd, that one naturally thinks of some abnormal mobility of the heart, to which Determann, A. Hoffmann, and others have given special attention. It is certainly possible that with an abnorm- ally heavy or movable heart a change of position caused a blocking of the circulation in the great vessels, which acted as a stimulus in producing extra-systoles. I was very much struck with the fact that they were extremely well marked in the cases of probably true bigeminy of the heart, which were already described in ^21, and will be discussed more fully again in § 68. I do not believe, how- ever, we are yet in a position to give a full explanation of the phenomenon of extra-systoles. Finally, a fourth class of persons suffering from extra-systoles comprises patients that have real organic disease of the heart. And in this class also it is true that the extra-systoles are in themselves of no diagnostic value in relation to the stage or extent of the cardiac lesion. It does not require any proof that the various affections of the heart, e.^. dilatation, inflammation, poor blood-supply to the muscle, over-exertion, can all provide stimuli to set up extra-systoles either directly or reflexly. And it is no less true that these abnormalities are not always bound to produce extra-systoles. We often see the very worst cases of heart disease, that lead shortly to the death of the patient, go on without any sign of extra-systoles, and particularly cases of real acute myocarditis, which go on with a high and increasing frequency to the end without the slightest disturbance of the rhythm. This statement is at variance with the old theory that arhythmia is a sign of cardiac disease. That it is