42 



Observation no. 47. 



Total block. Stokes-Adams' syndrome. 



P. C. Q., male, white, 18 years old, res- 

 ident at Mono da Oarça. 



The patient says he had ill-defined 

 attacks when a child; he has frequent attacks 

 of giddiness and about six months ago 

 convulsions. Six months ago he had milk- 

 pox. Complains of gastric pains with sensa- 

 tion of weight in the stomach. Intestinal 

 functions normal* Liver enlarged and pain- 

 less. Spleen slightly painful and enlarged. 

 Heart much enlarojed, measuring 16 cm. at 

 base. No murmur, but aUer each normal 

 systole is heard a muscular sound, appa- 

 rently due to the contraction of the auricle, 

 which is iregularly heard. Pulse arrhythmic; 

 slow; sometimes there seem to be extrasys- 

 tolic waves. 36 pulsations a minute. Tmx.= 

 135. Pulse lying down 36; standing 44. 



Record no. 46. 



July 5, 1911. Pulse slow and rhythmic, 

 34. Cardiogram more frequent than the pulse, 

 not full, with the auricular waves well mark- 

 ed in the diastolic phase and falling at 

 varying distances from the ventricular sys- 

 toles. The jugular tracing shows the c waves 

 placed in varying relations to a, there being 

 no dependence upon the latter. The a a 

 waves are frequent and rhythmic, 93 per 

 minute. The v waves show nothing note- 

 worthy. It is a record of easily interpreted 

 complete block. 



Observation no. 48. 



Ventricular extrasystoie evolving towards 

 complete block. 



J. C. F. R., male, white, 17 years old, 

 native of Lassance* This patient, who has a 

 goiter with a generalized enlarged thyroid, 

 came to the Hospital for the first time in 

 May, 1911. He had slight indications of car- 

 diac insufficiency and extrasystolic arrhyth- 

 mia. In January, 1915, about four years 

 liiter, he came back to consult in an asys- 

 tolic crisis, with slow and arrhythmic pulse 



The asystolic symptoms were improved, the 

 edema disappeared, but the arrhythmia re- 

 mained, with slow pulse. Heart much en- 

 larged. No murmur, or valvular lesions. 



Records no. 47 and 47-A. 



The records show the evolution of the 

 arrhythmia which is wholly extrasystolic in 

 the first record, and three vears and a half 

 afterwards has become a complete block 

 with extrasystoles. 



I) The collective record rhythmic, the 

 dominant rhythm interrupted by premature 

 beats of ventricular origin, with complete 

 compensating period, fl c interval not length- 

 ened. Nothing else worth mentioning. 



II) Taken three years and a half after 

 the former. 



The radial pulse is slow and irregular; 

 there are a few extrasystolic beats. The car- 

 d'ac record is defective, and furnishes few 

 data. In the jugular record a waves are 

 seen succeeding each other regularly and 

 much more numerous than the ventricular 

 beats c waves. The relation between a and 

 c varies every moment; at times they fall 

 together, at others a comes before c in va- 

 rying time, sometimes it comes after a. 

 The c waves of the ventricular extrasystole 

 interrupt the succession of a and c whicli 

 are regular, without any accidental connec- 

 tion which might be attributed to the auric- 

 ular waves. The record is of complete 

 block, with ventricular extrasystoles. 



Observation no. 49. 



Alteration o/ condiictibility with extrasys- 

 tole. Evolution of morbid process till comple- 

 te block. 



M. F. , male, 23 years old, white, resid- 

 ent at Lassance. 



He came to consult us stating that per- 

 iodically he has vertiginous crises with loss 

 of consciousness . Previous history unknown . 

 Lives in a house infestedby Triatoma. Fam- 

 ily history: His parents had extrasystolic 

 arrhythmia and hypertrophy of thyroid 

 gland. Three brothers with goiter and al- 



