26 



Record no. 20. 



An interesting formation of trigeminal 

 rhythm by the regular intercalation of ven- 

 tricular extrasystoles. They appear every 3 

 cycles, in tertian rhythm. Compare with 

 record 19. 



Observation no. 22. 



Ventricular extrasystoles in series. 



P. F. S. , white, male, 45 years, resid- 

 ent at Coração de Jesus. Signs of cardiac 

 insufficiency, Katzenstein's test positive. 

 Heart sounds muffled. Frequent extrasys- 

 toies. Liver enlarged and painful on press- 

 ure. Thyroid much enlarged. Cervical glands 

 enlarged. 



Record no. 21. 



The dominant rhythm is interrupted by 

 a series of six consecutive extrasystolic beats. 

 These beats are dueto extrasystoles of ven- 

 tricular origin; in another part of the tracing 

 is seen an isolated extrasystole which is also 

 ventricular. 



Observation no. 23. 



Ventricular extrasy^tole. Post- extrasysto- 

 lic alternation. Palpitation. Marked dilatation 

 of tfie heart. 



C. C. da S. mulatto, male, 27 years, 

 married, farm laborer, resident at Porto Fa- 

 ria. 



Examined September 12, 1912. 



No subjective signs, except occasional 

 passing attacks of palpitation. The patient 

 is tall, above middle height, well-built and 

 of robust appearance. Heart not enlarged, 

 apex beat in the fifth intercostal space out- 

 side and below the nipple, 14 cm. from 

 the midsternal line. Right margin 6 cm. 

 from the midsternal line. Heart sounds with- 

 out any marked alteration. No murmurs. 

 Pulse lying down 82, standing 107. 



I before -81 

 during -92 

 after -92 



Tmx=125. 



Pulse with numerous extrasystoles 

 Liver slightly enlarged. Spleen not noticeab- 

 ly enlarged. Goiter, thyroid gland moder- 

 ately enlarged. 



Record no. 22. 



Besides the falling out of the radial 

 pulse corresponding to the slight beats of 

 the cardiac tracing, there is a very marked 

 alternation in the beats which foilow the 

 lapses, which are extrasystoles and are not 

 registered in the pulse. These are ventricu- 

 lar. 



Record no. 22. 



The sphygmogram registers the inter- 

 ruption of the rhythm by extrasystolic beats 

 and lapses. The alternation of the pulse in 

 also noticeable and more apparent in the 

 pulsations that follow an extrasystole. The 

 extrasystoles are ventricular. 



Observation no. 24. 



Ventricular extrasystoles. Alternation oj 

 the pulse. 



T. X., male, 31 years, resident at Bel 

 trão. 



The patient came to consult us on ac- 

 count of fatigue, palpitation and gastric dis- 

 turbances. 



Heart enlarged, apex beat in the sixth 

 intercostal space outside the mammillary line, 

 the base measuring 16,3 cm. Pulse arrhyth- 

 mic, with lapses which correspond to the 

 extrasystolic beats in bigeminal series. Pulse 

 76 lying down, 74 standing up. Tmx=llO. 

 Thvroid enlarged with cystic goiter of the 

 middle lobe ; cervical and axillary glands en- 

 larged. The patient came back to consult us 

 three months later and was put in hospital 

 as he showed intense signs of cardiac in- 

 sufficiency, which brought on asystole. 



He was observed by a commission of 

 professors who were there at the time. This 

 case was considered very interesting from 

 a clinical point of view and one of the best 

 examples of the cardiac form. Furthermore 



