Cardiac fibrosis as a result of coronary obstruction / by G. A. Gibson and Robert Muir.

  • Muir Robert, Sir, 1864-1959.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Cardiac fibrosis as a result of coronary obstruction / by G. A. Gibson and Robert Muir. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    quently vomited undigested food. The bowels were con- stipated. The liver was slightly enlarged, extending from the fourth rib to an inch below the costal margin in the mammary line. There was no ascites. The patient was distinctly anaemic, and so pasty-looking as to suggest renal disease. There was no morbid appear- ance connected with the spleen or glandular apparatus. Dyspnoea was constant, but with paroxysmal exaggeration, especially at night. Some praecordial pain and considerable palpitation were complained of. On inspection and palpation of the neck and chest, no abnormal symptoms could be observed, except that the cardiac impulse was extremely weak. The radial arteries were some- what hard, but the vessels were unfilled, and the tension was moderate. The pulse was extremely frequent, varying from 130 to 150; it was perfectly regular, and the wave small. Cardiac dulness extended from 24 in. to the right to 4|- in. to the left of the midsternal line. On auscultation the heart sounds were extremely faint. A soft systolic murmur was heard over the prsecordia, but it was so feeble that it was difficult to follow its distribution with accuracy. There could be no doubt that it was loudest at the lower end of the sternum, but there was a probability that there were two other points of maximum intensity, one towards the apex of the heart, the other over the manubrium. Dulness was present at the bases of both lungs on account of double hydrothorax, and many crepitations were to be heard above the level of the fluid on either side. The urine was scanty, varying from 18 to 24 oz. per diem. It contained no albumin or tube-casts. Considerable oedema of the subcutaneous tissues was present in the lower limbs. The patient complained much of sleeplessness and rest- lessness. The diagnosis arrived at was cardiac failure, with mitral and tricuspid incompetence, in consequence of arterial degeneration, probably attended by some changes in the aortic cusps, from chronic atheromatous processes. The patient was treated by means of cardiac tonics: