86 



Scientific Proceedings (52). 



57 (753) 



Prolonged complete heart-block, without lesion of the bundle of 

 His and with frequent changes in the idio-ventricular 

 electrical complexes. 



By B. S. Oppenheimer and H. B. Williams. 



[From the Department of Physiology, Columbia University, New 



York.] 



Electrocardiograms were obtained at intervals from an old 

 hemiplegic patient who was known to have complete heart-block 

 from February 26, 1912, up to the day of his death, December 31 

 of the same year. During many months of this period he had 

 pronounced Cheyne-Stokes respiration. The interest in this case 

 lies in the fact that there were frequent changes in the electrical 

 complexes of the ventricular beat and correlated with this the 

 fact that histological examination revealed no organic lesion to 

 account for the block, in the auriculo-nodal junction, the node 

 of Tawara, or the main stem and its branches. The nodal artery 

 was sclerotic. 



The variations in the ventricular complexes were seen not 

 only from one examination to the next, but often from beat to 

 beat. 



The waves Q, R, S and T all showed variations; for example 

 with leads I and II the wave R was sometimes upright, sometimes 

 inverted. With lead III the wave R was always inverted. 



The auricular rate was strikingly reduced during the dyspneic 

 period (44.49 beats per minute), as compared with its rate during 

 apnea (94.17 beats per minute). The ventricular rate was only 

 slightly reduced during dyspnea (30.46 beats per minute as com- 

 pared with 31.25 beats per minute). In other words the vagus 

 still had a marked chronotropic effect on the auricle and little if 

 any on the ventricle. Two atropin tests were made during which 

 the heartblock was not relieved; and, again, the auricular rate 

 was decidedly increased, the ventricular rate very slightly so. 



To explain the divergent types of ventricular complexes we 

 may consider the possibility that the intrinsic ventricular pace- 

 maker was frequently shifting, or that the different impulses 



