Transient auriculoventricular dissociation with varying ventricular complexes caused by digitalis / Henry A. Christian.

  • Christian, Henry A. (Henry Asbury), 1876-1951
Date:
1915
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Licence: In copyright

Credit: Transient auriculoventricular dissociation with varying ventricular complexes caused by digitalis / Henry A. Christian. Source: Wellcome Collection.

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    block in the auriculonodal junction, the node of Tawara or the main stem and its branches. The nodal artery was sclerotic. The variations in the ventricular complexes were seen not only from one examination to the next but often from beat to beat. The waves Q, R, S and T all showed variations; for example in Leads 1 and 2 the R waves were sometimes upright and sometimes inverted. In Lead 3 the wave R was always inverted. The patient had marked Cheyne-Stokes respira¬ tion and the auricular rate was strikingly reduced during the dyspneic period, while the ventricular rate showed little change. • Case 1.—The patient was in the Peter Bent Brigham Hospital on two occa¬ sions; the first time (Peter Bent Brigham Hospital Medical No. 426) from Oct. 18 to Dec. 18, 1913; the second time (Peter Bent Brigham Hospital Medical No. 939) from March 11 to April 5, 1914, on which day he died. Fig. 1, Case 1.—Lead I, taken March 20, 1914. Fig. 2, Case 1.—Lead I, taken after Figure 1, March 20, 1914. The patient, a man aged 48, had been somewhat short of breath for the past two or three years, but not enough to keep him from his work, that of a barber. He had had more or less swelling of his ankles for ten years. During the winter prior to admission he had a chronic cough. About two months before admission he noticed that he was sleeping poorly and shortly after this his breath became very short, particularly at night, so that he was obliged to sleep sitting propped upright in bed. When he first entered the hospital the right border of cardiac dulness was at the right sternal margin; the left border 9 cm. to the left of the midsternum. The apex beat was not seen or felt. Cardiac sounds were distant and a faint, blowing systolic murmur was heard, loudest at the apex. There were four or five beats of the same length followed by an extra beat, evidently an extra systole. The abdominal wall was edematous and brawny without shifting dulness. There was a brawny edema of the arms and legs. The patient responded well to digitalis, and had a marked diuresis with disappearance of his edema. There was considerable evidence that in addition