POLYSPHYGMOGRAMS 



279 



of a two-in-one heart-block. When on the other hand, there is no exact 

 ratio between the slow and the rapid rate, the change is due to the sud- 

 den appearance or disappearance of paroxysmal tachycardia. The 

 paroxysms during which the auricle is beating very rapidly may last for 

 a variable time, such attacks persisting off and on for hours or even days. 

 The tracing in such a case is given in Fig. 102. 



Fig. 103. Auricular flutter. In this case the ventricular rate varied from 82 to 98 per minute. 



(From E. P. Carter.) 



Auricular Flutter. It is impossible to diagnose the not infrequent 

 existence of this cardiac condition without the use of either the poly- 

 sphygmogram or the electrocardiogram. The jugular curve may be of 

 two types, one made up of rapid, more or less uniform waves, the other 

 of waves that are paired with a constant time interval between the pairs. 



Fig. 104. Auricular flutter. Note the relative rates of A and V, and also that the ventricular 

 rate is regular. (From E. P. Carter.) 



All of the frequent beats of the auricle do not reach the ventricle in this 

 condition, so that the ratio between auricular and ventricular beats 

 may be 1:3 or 1:4. The condition must therefore not be confused with 

 heart-block, the main point of distinction being that in the latter condi- 

 tion the ventricular pulse is slow and the auricular about normal. The 



