Description of a heart showing gummatous infiltration of the auriculo-ventricular bundle / by Arthur Keith and Charles Miller.

  • Keith, Arthur, Sir, 1866-1955.
Date:
[1906]
Catalogue details

Licence: In copyright

Credit: Description of a heart showing gummatous infiltration of the auriculo-ventricular bundle / by Arthur Keith and Charles Miller. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    its course the anterior interventricular branch showed thick- enings in its wall which narrowed the lumen to half its normal size. Any obstruction to the flow of blood along the anterior interventricular artery is always followed by the peculiar localised dilatation of the left ventricle, which is shown in Fig. 2, m. From the condition of the arteries we may infer that the blood-supply of this heart had been reduced to half the normal amount, probably even less than half. To sum up, the heart of this man was reduced to the following condition: the superior vena cava was completely destroyed; the coronary sinus was involved in a cicatrix; the sinus of the left auricle formed a cicatricial ring; the inter- auricular and part of the interventricular septum formed a cicatricial lamina; the commencement and upper half of the main auriculo-ventricular bundle were completely destroyed; and the coronary arteries were partially occluded. Yet with the complete separation of the musculature of the auricles and ventricles there had been only passing syncopal attacks some 13 years before, which was probably the date at which the auriculo-ventricular bundle was first invaded by the infil- tration ; there were no signs of heart failure, and there were no urgent symptoms of insufficiency of the heart’s action. The lesson to be drawn from the case appears to be that the normal mechanism of the heart may be profoundly changed without a great disturbance of function, provided that these changes are not brought about too suddenly. The recovery which followed the initial syncopal attacks was probably due to the auriculo-ventricular system persisting beyond the point of lesion and taking on an automatic power of originating ventricular contraction. Unfortunately, the routine method of examining the heart does not give us exact facts relating to the action of the several parts of the heart. The lack of such data shows us the necessity of applying to the heart the exact methods of the physiologist, as has been done with success by Mackenzie and Wenckebach.