Volume 1

Clinical disorders of the heart beat : a handbook for practitioners and students / by Thomas Lewis.

  • Lewis, Thomas, Sir, 1881-1945.
Date:
1913
Catalogue details

Licence: Public Domain Mark

Credit: Clinical disorders of the heart beat : a handbook for practitioners and students / by Thomas Lewis. Source: Wellcome Collection.

    103/136 (page 87)
    Morbid anatomy. That valve lesions are present in a number of the cases is obvious from the bedside examinations ; enlargement of the whole heart is common, and dilatation or hypertrophy of the auricles is more frequent than the valve lesions which might be held to account for them. The most constant structural alterations, which are found, are discovered by histological examination of the heart muscu¬ lature. Usually it shows a more or less intense grade of subacute or chronic inflammatory change progressing to fibrosis, and the auricles are conspicuously affected. A diffuse fibrosis, accompanied by leucocytic infiltration and atrophy of the neighbouring muscle cells, is the most frequent change. Such is the tale told by the microscope, but it does not justify us in holding that the inflammatory reaction is the cause of the altered mechanism. We examine the hearts of those who die, and most die with all the classical signs of heart failure. Many of the microscopic lesions are to be regarded as the result of infections producing heart failure rather than fibrillation. Similar lesions are found where fibrillation has never occurred ; and hearts which have shown this disorder may not present the lesions described. The recognition of auricular fibrillation. Auricular fibrillation gives rise in a clinical case to two series of phenomena ; the one dependent upon the virtual paralysis of the auricle ; the other dependent upon the irregularity of the ventricle. It will be convenient to study the ventricular signs first. The irregularity is most varied in form according to the rate of the contractions. When the heart is beating rapidly at 100-160 per minute, the grade of disorder is maximal. The radial artery supplies indifferent news of the ventricular rate, many pulsations fail to reach it (such beats are marked with asterisks in Fig. 46). The jmlse is a medley