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La dérivation auriculaire S5 et la trémulation auriculaire
BOOK
tj:3:,
REVIEWS
and the nature of the angina1 attack, he takes up the different operations, which he lists as those having an anatomical basis (that is, those operations that seek to interrupt the pain pathways) and those with a physiological basis (those wh?h :tirn to interrupt t,he reflexes initiating an attack or to establish coronary vasodilatation). by Drs. Lrriclfr :tnll Of the various procedures he favors stellectomy as performed Fontaine. He also discusses the possibility of rrvascularization, citing Beck’?: wtrrk He gives brief vase reports of thirty WW~ (11 in Cleveland, and totin thyroidectomy. total thyroidentomy from the Peter Bent Brigham Hospital and comes to the vc’ry tlefinit,e conclusion that the results of this form of trtaatment are unsatisfactory. Dr. BErard has provided an interesting summarp of what has been done or attempted surgically for the relief of angina pectorie. .is H summary the book r~oul~l be greatly cOondensed with advantage. While angina pcctorix is very ~'On1IllOll. tflt‘ qurgitxl treatment is relatively unusual, and in spite of this vf~lumr anI1 :I long bihliogrsphy, the final word on the subject has not hern q)okPn.
The author provides a detailed bacteriological am1 amxtoruical endocarditis, considering the lesions of arteries and of other organs of the heart. He has succeeded in producing the disease in dogs the experimental findings add to au understanding of the disease in are illustrated by means of photographs and rni~~rophotogr;ll,l~r, and sivr hihliography.
study of ba&rial as well as those and beliert% that man. The I~ions there is an &WI-
L'E~SOLIE PVLMONAIRE. RECHISWHES CLINIQCES, AKATOMIQPES, PATHO&~IQI:KH ET TH~RAPPEUTIQUES STR LES EIS~BOLIESET LES INFARYTTJS DC POW&ON. By l’ierw Bardin. 192 pages Cie, price, 35 fr.
with
I1
figures
and
2 colored
plates.
Paris,
1937,
Masson
6
The thesis of this volume is the importance of nervous reflexes in tase* of pulmonary embolism. Dr. Bardin notes that sudden riesth after pulmonary emholisnr does not bear a definite relation to the size of thP vessel occluded and that thorat~i~ surgeons can tie off a large pulmonary vessel without, producing sudden death. HG believes that when sudden death OWWR it is the result of a reflex arifiing from the effect of embolic material on the nerve endings of the pulmonary nrleriol~~ is an important fiCt,Or in this and that a nervous predisposition, a hypervagotonia, reflex. He believes that with art.erial obstrurtion anywhere in the body the exGt:ttion of nervy in the vessel wall is far more impflrtant thdn obstruc>tion to the flo% ot’ blood. Dr. Bardin reviews the experimental work of others and his own work. In dog?-* he found it practically impossible to produce sudden death from a large pulmonary embolus and he has studied in detail the effect of various procedures designed to alter the neurovegetative or humoral conditions and so to study the reflexes arising from pulmonary embolism under different experimental conditions. The author also discusses treatment and give s an extensive bihliogrdphy. n’hilt~ interesting from an experimentitl point of rirw, the hook has many weaknesses on the clinical side.
LA DEPRIVATIONAUPXULAIRE Preface Stimulated dealing with lead (called
by
Professor
85
ET LA TR~MCLATION AURICULAIRE. By B. Pinuhcnzon.
C. Lian.
80 pages.
Paris,
by his master, Professor Lian, Pinchenzon two subjects; first, the vrtlue of a certain S5), with one electrode over the manuhrium
1937.
J.-B.
BailliPre
et Fils.
has written a short book electrocardiographic chest Pterni and the other at the
640
THE
AMERICAN
HEART
JOURNAL
inner end of the fifth right intercostal space, in revealing the electrical activity of the auricles when obscurely shown in the classical leads, and second, the clinical analysis of the intermediate stage of the auricular circus movement between auricular fibrillation and auricular flutter, variously Iabelled in the past as flutter-fibrillation or impure flutter or coarse fibrillation, but which Pinchenzon and Lian would like to establish as a definite electrocardiographic and clinical entity called “auricular tremulation. ’, The author appends “auricular tremulation’,
20 brief case reports and publishes and one showing “fibrillo-tremulation.”
two
records
showing
Doctors Pinchenzon and Lian have done us a service in calling attention again to the value of certain chest leads in studying aurieular action when the classical leads fail to define it. The very first human electrocardiogram ever published was from a chest lead in the days before the more convenient limb leads were arbitrarily selected. Then later on Lewis and others reintroduced chest leads for the study of auricular activity, but these did not assume any important place in clinical electrocardiography, largely because of the apparent rarity of their need. In this country, the recent introduction of chest leads in routine electrocardiography for the detection of ventricular myocardial disease has proved so important and valuable that the less important chest lead points, such as Lian and Pinchenzon’s Lead 55, for the study of the auricles have been overlooked. It may well be that on certain occasions they should be employed, not only this particular lead labelled S5 but others perhaps at various angles to it; other features of auricular activity not clearly shown by Lead S5 might thereby be revealed. “ Auricular tremulation ’ , as a designation for the stage of the auricular circus movement intermediate between auricular flutter and auricular fibrillation does not seem advisable as yet for routine use until further work and experience have proved its value. It may well turn out to be a more satisfactory term than flutter-fibrillation if it can cover the range of circus movements between flutter and fibrillation, but it seems likely that there are still border lines which would have to be designated “ tremulation-flutter , ’ or “ tremulation-fibrillation., ’ Rather than to introduce a new term for such, why not use as needed the terms we already have, in gradation flutter, impure flutter, fibrillation-flutter, flutter-fibrillation, coarse as follows: fibrillation, and fibrillation. However, the utility and wisdom of such subdivision are frankly open to question. To the reviewer the term flutter-fibrillation is still adequate to cover the range of auricular arrhythmia between flutter and fibrillation. He and most others have employed the term to signify this intermediate mechanism, labelled in this book auricular tremulation, and not to signify alternate periods of auricular fibrillation and auricular flutter which should be designated by point of time, not as a joint arrhythmia. Fortunately, clinically it is of little importance apparently to identify this particular phase of auricular arrhythmia-tremulation-by a chest lead, for etiologically, prognostically, and therapeutically it appears to have the same significance as auricular fibrillation and auricular flutter and should so be treated, as it doubtless is being treated most of the world over. However, the skepticism of the reviewer should not by any means be considered as a bar to the further study of auricular action by chest leads or to the analysis of this auricular mechanism intermediate between flutter and fibrillation which Doctors Lian and Pinchenzon have called tremulation, a good term if further study justifies its adoption. A further point of interest in research would be to see if other chest leads at other angles might not reveal, even better than 55, circus waves that might bo traveling in planes that are not well represented by 85.
tj:3:,
REVIEWS
and the nature of the angina1 attack, he takes up the different operations, which he lists as those having an anatomical basis (that is, those operations that seek to interrupt the pain pathways) and those with a physiological basis (those wh?h :tirn to interrupt t,he reflexes initiating an attack or to establish coronary vasodilatation). by Drs. Lrriclfr :tnll Of the various procedures he favors stellectomy as performed Fontaine. He also discusses the possibility of rrvascularization, citing Beck’?: wtrrk He gives brief vase reports of thirty WW~ (11 in Cleveland, and totin thyroidectomy. total thyroidentomy from the Peter Bent Brigham Hospital and comes to the vc’ry tlefinit,e conclusion that the results of this form of trtaatment are unsatisfactory. Dr. BErard has provided an interesting summarp of what has been done or attempted surgically for the relief of angina pectorie. .is H summary the book r~oul~l be greatly cOondensed with advantage. While angina pcctorix is very ~'On1IllOll. tflt‘ qurgitxl treatment is relatively unusual, and in spite of this vf~lumr anI1 :I long bihliogrsphy, the final word on the subject has not hern q)okPn.
The author provides a detailed bacteriological am1 amxtoruical endocarditis, considering the lesions of arteries and of other organs of the heart. He has succeeded in producing the disease in dogs the experimental findings add to au understanding of the disease in are illustrated by means of photographs and rni~~rophotogr;ll,l~r, and sivr hihliography.
study of ba&rial as well as those and beliert% that man. The I~ions there is an &WI-
L'E~SOLIE PVLMONAIRE. RECHISWHES CLINIQCES, AKATOMIQPES, PATHO&~IQI:KH ET TH~RAPPEUTIQUES STR LES EIS~BOLIESET LES INFARYTTJS DC POW&ON. By l’ierw Bardin. 192 pages Cie, price, 35 fr.
with
I1
figures
and
2 colored
plates.
Paris,
1937,
Masson
6
The thesis of this volume is the importance of nervous reflexes in tase* of pulmonary embolism. Dr. Bardin notes that sudden riesth after pulmonary emholisnr does not bear a definite relation to the size of thP vessel occluded and that thorat~i~ surgeons can tie off a large pulmonary vessel without, producing sudden death. HG believes that when sudden death OWWR it is the result of a reflex arifiing from the effect of embolic material on the nerve endings of the pulmonary nrleriol~~ is an important fiCt,Or in this and that a nervous predisposition, a hypervagotonia, reflex. He believes that with art.erial obstrurtion anywhere in the body the exGt:ttion of nervy in the vessel wall is far more impflrtant thdn obstruc>tion to the flo% ot’ blood. Dr. Bardin reviews the experimental work of others and his own work. In dog?-* he found it practically impossible to produce sudden death from a large pulmonary embolus and he has studied in detail the effect of various procedures designed to alter the neurovegetative or humoral conditions and so to study the reflexes arising from pulmonary embolism under different experimental conditions. The author also discusses treatment and give s an extensive bihliogrdphy. n’hilt~ interesting from an experimentitl point of rirw, the hook has many weaknesses on the clinical side.
LA DEPRIVATIONAUPXULAIRE Preface Stimulated dealing with lead (called
by
Professor
85
ET LA TR~MCLATION AURICULAIRE. By B. Pinuhcnzon.
C. Lian.
80 pages.
Paris,
by his master, Professor Lian, Pinchenzon two subjects; first, the vrtlue of a certain S5), with one electrode over the manuhrium
1937.
J.-B.
BailliPre
et Fils.
has written a short book electrocardiographic chest Pterni and the other at the
640
THE
AMERICAN
HEART
JOURNAL
inner end of the fifth right intercostal space, in revealing the electrical activity of the auricles when obscurely shown in the classical leads, and second, the clinical analysis of the intermediate stage of the auricular circus movement between auricular fibrillation and auricular flutter, variously Iabelled in the past as flutter-fibrillation or impure flutter or coarse fibrillation, but which Pinchenzon and Lian would like to establish as a definite electrocardiographic and clinical entity called “auricular tremulation. ’, The author appends “auricular tremulation’,
20 brief case reports and publishes and one showing “fibrillo-tremulation.”
two
records
showing
Doctors Pinchenzon and Lian have done us a service in calling attention again to the value of certain chest leads in studying aurieular action when the classical leads fail to define it. The very first human electrocardiogram ever published was from a chest lead in the days before the more convenient limb leads were arbitrarily selected. Then later on Lewis and others reintroduced chest leads for the study of auricular activity, but these did not assume any important place in clinical electrocardiography, largely because of the apparent rarity of their need. In this country, the recent introduction of chest leads in routine electrocardiography for the detection of ventricular myocardial disease has proved so important and valuable that the less important chest lead points, such as Lian and Pinchenzon’s Lead 55, for the study of the auricles have been overlooked. It may well be that on certain occasions they should be employed, not only this particular lead labelled S5 but others perhaps at various angles to it; other features of auricular activity not clearly shown by Lead S5 might thereby be revealed. “ Auricular tremulation ’ , as a designation for the stage of the auricular circus movement intermediate between auricular flutter and auricular fibrillation does not seem advisable as yet for routine use until further work and experience have proved its value. It may well turn out to be a more satisfactory term than flutter-fibrillation if it can cover the range of circus movements between flutter and fibrillation, but it seems likely that there are still border lines which would have to be designated “ tremulation-flutter , ’ or “ tremulation-fibrillation., ’ Rather than to introduce a new term for such, why not use as needed the terms we already have, in gradation flutter, impure flutter, fibrillation-flutter, flutter-fibrillation, coarse as follows: fibrillation, and fibrillation. However, the utility and wisdom of such subdivision are frankly open to question. To the reviewer the term flutter-fibrillation is still adequate to cover the range of auricular arrhythmia between flutter and fibrillation. He and most others have employed the term to signify this intermediate mechanism, labelled in this book auricular tremulation, and not to signify alternate periods of auricular fibrillation and auricular flutter which should be designated by point of time, not as a joint arrhythmia. Fortunately, clinically it is of little importance apparently to identify this particular phase of auricular arrhythmia-tremulation-by a chest lead, for etiologically, prognostically, and therapeutically it appears to have the same significance as auricular fibrillation and auricular flutter and should so be treated, as it doubtless is being treated most of the world over. However, the skepticism of the reviewer should not by any means be considered as a bar to the further study of auricular action by chest leads or to the analysis of this auricular mechanism intermediate between flutter and fibrillation which Doctors Lian and Pinchenzon have called tremulation, a good term if further study justifies its adoption. A further point of interest in research would be to see if other chest leads at other angles might not reveal, even better than 55, circus waves that might bo traveling in planes that are not well represented by 85.