Observations upon a curious and not uncommon form of extreme acceleration of the auricle : "auricular flutter" / by Thomas Lewis.
- Thomas Lewis
- Date:
- [1912]
Licence: Public Domain Mark
Credit: Observations upon a curious and not uncommon form of extreme acceleration of the auricle : "auricular flutter" / by Thomas Lewis. Source: Wellcome Collection.
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![[Reprinted from ‘ Heart.” Vol. IV, No. 2, November 30, 1912.] | OBSERVATIONS UPON A CURIOUS AND NOT UNCOMMON FORM OF EXTREME ACCELERATION OF THE AURICLE. “ AURICULAR FLUTTER.” By THOMAS LEWIS.* (Cardiographic Department, University College Hospital Medical School). Introductory Remarks. Four years ago Hertz and Goodhart! published the notes of a case in which it was evident that the auricles had assumed a very rapid action. The case was one in which the auricles contracted at a rate varying between 216 and 234 per minute, while the ventricular action was slow. Isolated cases of a similar nature have since been recorded by Jolly and Ritchie,? by Rihl,® and by myself.’ The condition has been regarded by those interested in the recent progress of cardiac investigation as a rare affection. While patients in whom a slow or irregular ventricular action have been more and more extensively investigated by means of graphic methods, the necessity for a routine examination of simple cardiac accelerations in the same manner has not been recognised. It appears, as I hope to show in the present communication, that extreme acceleration of the auricular contractions to a rate of 300 per minute is not an infrequent human malady; and that the combined picture of auricular acceleration and heart-block is relatively common. It will also become apparent that if the routine examination of patients who present rapid heart action by modern methods, and especially by electrocardiographic means, is not undertaken, the condition will often escape detection. A series of cases which has recently come under the observation of the writer has clearly shown, not only that such examination is imperative if the true nature of a given tachycardia is to be ascertained, for such cases may readily pass for other and more simple forms of acceleration, but that a detailed acquaintanceship with the forms which the electrocardiographic curve may take is essential. In most instances there are few or no signs of the extreme auricular acceleration, other than those found in the electro- cardiographic pictures ; and in many of these, the degree of acceleration is by no means obvious if such curves are hastily scanned. The reason for the obscurity of the signs is twofold, for, in the first instance, the auricular contraction rate is usually double the ventricular, and alternate auricular systoles are buried in the ventricular systole and pass unnoticed ; and, in the second instance, the systoles of the auricles have little mechanical effect upon the blood content of either veins or ventricles, and the movements of the auricular walls are small. * Working under the tenure of a Beit Memorial Fellowship.](https://iiif.wellcomecollection.org/image/b3343069x_0003.jp2/full/800%2C/0/default.jpg)
