34 



atropine, the pulse has become regular, the 

 conductibility being reestablished. The a c 

 interval is normal. The pulse was a little 

 accelerated. 



Observation no. 36. 



Ventricular extrasystoles. Partial block. 



T M. P., 58 years resident at Pilar. 



Examined June 2, 1911. Complains of 

 palpitation with continual giddiness. Pulse 

 59 with frequent lapses. Hypertrophy of the 

 thyroid. 



Record no. 35 



The pulse is arrhythmic, the arrhythmia 

 being caused bv complete lapses and pre- 

 mature beats which interrupt the dominant 

 rhythm iiregularly. The cardiac tracing does 

 not furnish any indications that can be used, 

 as the respiratory movements affect it a 

 great deal. The collective analysis of the 

 tracings shows that the lapses of the pulse 

 are caused by the irregular block of auri- 

 cular waves. Thus between the beat III and 

 IV an a wave is seen in the jugular pulse ; 

 this wave is seen in the cardiac tracing as 

 well is in the catacrotic wave of beat 111, but 

 there is no corresponding ventricular systol- 

 ic wave. The same is repeated in beat 

 VIII— IX and in other parts of the tracing. 



Beat X is premature, as a result of a 

 ventricular e^^trasystole which falls at the 

 same time as the auricular systole of the 

 dominant rhythm. Other extrasystoles are 

 seen in the tracing, all of them ventricular. 

 The a waves appear rhythmically in the 

 jugular pulse, the a c interval lengthening 

 shghtly and gradually until the block, as 

 may be seen in beats IV to VIII. 



Observation no. 37 



Partial block. Rhythm 2:1 and 1:1, al- 

 ternating irregularly. Giddiness. 



A. D., negro, male, 27 years old, labor- 

 er, married, resident at Piedade. 



Has had intermittent fevers for many 

 years. A year ago he had milkpox. Has gon- 



orrhea and venereal chancres. He has been 

 ill for a long time, with an undefined un- 

 easiness, which however did not prevent him 

 from working. Has frequent attacks of gid- 

 diness, sometimes vertigo and falls. Rarely 

 has palpitation. Dyspnea on exertion. These 

 symptoms have become worse lately; the 

 last few days he has had edema of face 

 and abdomen. Heart not enlarged. Apex 7 

 cm. from the midsternal line and right mar- 

 gin 3 cm. Apex beat below and within the 

 nipple. Heart sounds muffled. Pulse ample, 

 strong, arrhythmic and irregular, accompa- 

 nying the heart beats. Series of frequent 

 beats interrupted by slow series. In the long 

 ventricular diastoles is heard a sound which 

 is probably auricular. Jugular pulse hardly 

 visible. Pulse 56 per minute, varying, how- 

 ever, according to the number of the slow 

 beats. Tmx. =140. Atropine test. (See trac- 

 ings). Liver, left lobe enlarged. Spleen not 

 palpable. Thyroid enlarged. Inguinal glands 

 not enlarged. 



Record no. 36. 



The radial tracing shows beats somt^- 

 times more rapid; the interval between the 

 systoles of the slow beats is perceptible, but 

 not strictly equal to twice the rapid beats. 

 The cardiac tracing shows, besides the iden- 

 tical i-hythm, very clear a waves which are 

 followed or not by ventricular systolic waves. 

 The a waves which are not accompanied 

 by ventricular systoles correspond to the 

 catacrotic phase of the pulse waves of 

 the slow rhythm. In the jugular tracing are 

 seen a waves which succeed each other in 

 regular intervals. They are not all, however, 

 followed by a ventricular systole, some 

 waves being blocked. In the beats I to 

 IV the block occurs in the rhythm of 2:1. 

 The beats V and VI follow in the rhythm 

 1:1, with gradual increase cf the a c inter- 

 val and the rhythm that of partial block; 

 2: 1 reoccurs following the VI beat. The 

 gradual lengthening of the a c is marked. 



