51 



Records no. 56 and 36-A. 



I) The heart and pulse records show 

 marked ventricular arrhythmia, so that the 

 dominant rhythm could not be fixed. The 

 beats are frequent and completely irregular ; 

 in the jugular record are seen auricular 

 waves in rhythmic succession and with great 

 frequency: 290 to the minute. The ventri- 

 cle does not answer to all excitations, many 

 being blocked in a variable way from one 

 to another cycle. Some beats apparently 

 extrasystolic though it is impossible to say 

 if they really are. 



II) Taken three days after the latter; 

 the patient had taken digitol The number 

 of auricular beats diminished a little, from 

 290 to 260. The auricular waves well mark- 

 ed; in the venous pulse they arc irregular- 

 ly blocked and the digitol has intensified 

 the block; in some points there are 7 auric- 

 ular beats to 1 ventricular oiie. The ven- 

 tricles beat more slowly on account of the 

 more intense block, but still very irregu- 

 larly. 



Observation no 5S. 



Auriciiiar tachycardia with transition to 

 fibrillation. Cardiac insufficiency. 



A. M., mulatto, female, 35 years old, 

 living in Pirapora 



Signs of cardiac insufficiency. Heart 

 enlarged; Ó2 beats with extrasystoles and 

 alterations of conductibility. Tmx.=100. 

 Liver enlarged. Large goiter. Strong bronze 

 coloring. 



Examined April 19, 1912. 



She complains of genera! uneasiness 

 with great sadness. Dyspnea on exertion 

 which has increased gradually to such a 

 point that it appears even when resting; it 

 is accompanied by a cough. Lately edema 

 appeared. She has vertigo sometimes with 

 falls. Heart greatly enlarged, the base line 

 measuring 16 cm. The heart beats shake 

 the thoracic wall; and the rate is sometimes 

 107. Many systoles are not perceptible in 

 the pulse, where 56 beats are to be count- 



ed. Systolic murmur at apex, propagating 

 itself to axilla. Tmx.=r^l20. Tmn. ^^95. Liv- 

 er much enlarged. Spleen enlarged and 

 hardened. Thyroid with some hard nodules . 

 Congestion of pulmonary bases especially 

 the left. The condition varies; the patient 

 is sometimes better, sometimeaí worse . 



July 23, 1913. 



General condition worse. Stitch in left 

 side. Intense dyspnea. Cyanosis. Bloody 

 sputum. Slight edema of lower extremities. 

 Cardiac beats very irregular, now slow, now 

 fast, sometimes very frequent, with trembling 

 that cannot be counted. Pulse varying, on 

 an average 56 beats. Heart much enlarged . 

 Apex seventh space, 14 cm. from the mid- 

 sternal line. Right margin 2 cm. from 

 middle line. Liver enlarged. Signs of pul- 

 monary engorgement at the right base. 



July 28, 1912. 



Pleurisy with effusion on the right. 

 Bloody sputum. Cardiac bigeminism (digi- 

 talic) 78 heart beats; pulse 39. No percep- 

 tible change in the size of the heart. No 

 murmurs. Sleepiness. Vomits. Cough with 

 bloody sputum. Pain at the right side of 

 thorax. Cyanosis, Slight edema of lower 

 limbs. Pleural effusion increased. Bigeminism 

 continues. 68 cardiac beats ; radial pulse 39. 

 The pleural fluid was extracted, and was 

 serohemorrhagic. Patient got alternatively 

 better and worse, and died on August 22, 

 1912 in syncope. 



Records nos. 57, 57-A, 57-B and 57-C. 



I) Examination of the three records 

 shows first the great irregularity of the ra- 

 dial pulse and of the cardiac beats which 

 succeed each other arrhythmically, at a rate 

 of more or less 93 beats. The auricles beat 

 perceptibly twice as often as the ventricles, 

 170; auricular a waves are seen in the ju- 

 gular pulse. The irregularity of the pulse 

 comes from the block of the auricular 

 waves, in varying numbers, from one cycle 

 to another, and perhaps from extrasystoles. 



II) This record was made about a year 

 after the other and shows the radial pulse 

 with the appearance of a completely ar- 



