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Paroxysmal complete heart block alternating with normal rhythm and conduction
Hecht,
Ii.:
klin .A.Med
Precordial
Leads in Clinical
Electrocardiograms.
I)eutwhw
l\~~~l,.
I’.
179’ *, 1 IWC.
The author used two precordial regions for the exploring electrode ( thirtl inltbrspaw to the right of the sternum and the sixth interspace over the aprxj, his fiuwl electrode being the null point electrode of Wilson. Tile contour of the recwr~ls io 200 normal and cardiac patients is described. In left preponderance a flattt’nin;: of T was found in the apical lead; in righf preponderance a rernsal of alI tlltl complexes was found in the basal lead. This permitted him to distinq&h brtu-rcrr axis shift and preponderance. The value of thew leads in flutter and fihrillat,icm rlf the auricles is emphasized, and they show changes in S-T and T-naws early NIL al) normal hearts. I.. s. ii.
Spiihler,
0. :
Adams-Stokes
The author finds ventricular fibrillation
Syndrome.
that Adams-Stokes as by standstill
Ztwhr.
f.
ryndromr of the h~ri.
klin.
129: 693,
~1~1.
is c~;~urrtl
as often
by
1936.
tr:tnhilxllt
I,. N.
Marzahn, H. : Electrocardiographic 130’ * 1::5 1 193li.
Studies During
Work.
Ztwhr.
f.
klin.
Ii. ~1~~11.
\Vllen work caused an acceleration of the Iwart to 200 bwts twr miuutcx, the au1 1101 Fuuml that the QRIc span was shortenrd by 11.0 I swond. Estrasystoles temlwi IO appear, but extrasystoles present at rest tendfsll to disappear. So differenct. \viis noted in the appearance, disappearawe. and inagnitu~lr ~,f the wrdiac acceleration between normal and cwdiac patients. -In awPI~~r:lti
With Normal
The literature of recurrent complete heart-blwk :lltc~rn:tting with tion and accompanied by Adams-Stokes syndrome has born (wwlined L’O potential cases discovered in the literature, I:! have hren awepted with the criteria established. The important calinif+al, pathologiral, cardiographic data of these cases have been wtnrnariw~l.
normal von~ll~rcritically. Of as wrtlplyiog awl clwt re)-
.\ MW, a woman aged seventy-eight, with Mams-Stokes P,vwlrome, is prewLt+~ti in whit-h. as shown by electrocardiographic evidence, complete heart-block alternatfxd with normal rhythm and conduction. The results lvith atropine demonstratc~d that This case ultimatt:ly the cdhanges probably owurred independent of any vagus effect. Ilwelope~l a chronic complete block with the spontanr~w tlihappeararwe (II‘ thv s~ncop:~l attacks. The graplli(*
form of the transition from tracings, is summarized.
The practical phasized.
diagnostic
and
one degree
therapeutic
ot’ ~~on~lnction eonriderations
111 another. of thi,
3s rtrlwrl
Iaondition
IIF
are tw
374
THE
AMWICAN
HEART
JOURNAL
The pathogenesis of paroxysmal complete heart-block is discussed. It is probable that the majority of cases are on an arteriosclerotic basis and that either a fibrocalcareous mass or fibrosis due to coronary sclerosis partially damages the bundle of His. The fluctuating character of the conduction in these cases is probably determined by temporary variations in the local circulation to the remaining intact fibers. AUTHOR.
Grosse-Brockhoff, F., and Strotmann, Systole and the Electrocardiogram. The volume curves and optical anesthetized rabbits, simultaneously stant relation was found between systole. It was found that the mechanical systole, and the ratio the duration, let alone the power
Heim, F.: Med.
Conduction
98:
551,
A.:
The Time Relation Ztschr.
Between
f. d. ges. exper.
Med.
Mechanical 98:
227, 1936.
carotid artery pressure curves were recorded in with Lead I of the electrocardiogram. No conthe end of the T-wave and the end of the mechanical Q-T interval is not equal to the duration of the between the two is inconstant. One cannot judge of systole from the electrocardiogram. I,. N. K.
Disturbances
in Human
Heart.
Ztschr.
f. d. ges.
exper.
1936.
The relation of the P-R interval to the duration of the cycle is determined and shown to give a smooth curve. It is shown that the P-R interval does not lengthen as much as anticipated following interpolated auricular extrasystoles, presumably because the refractory period is shortened as the heart rate accelerates. The Wenckebach phenomenon in the digitalized heart with A-V block is attributed to progressive lengthening of the refractory period from beat to beat unt,il a ventricular beat is dropped and the refractory phase is shortened again. L. N. K.
Zlrday,
I. V.:
exper.
Med.
Electrocardiographic 98:
662,
Studies of the Auricles.
Ztschr. f. cl. ges.
1936.
The author used unipolar chest leads and could distinguish the action of each of the auricles. He demonstrated an asynchrony of 0.01 to 0.09 second between the onset of electrical activity in the two auricles. Leads I and III, according to the author, give only the P-wave of the left auricle, while the P-wave in Lead II is Splintering of P, is due to intera summation of the activity of the two auricles. aurieular block, and this block is the cause for a difference in t,he P-R interval in Leads I and II. (The interesting observations need confirmation.) L. N. K.
Lewis, J.
Auricular Thomas: 1: 1248, 1937.
Flutter
Continuing
for Twenty-Four
Years.
Brit.
M.
The case is of exceptional interest for three reasons. First, the auricles seem to have fluttered without cessation for twenty-four (if not twenty-seven) years. Secondly, although the ventricle during the greater part of the period has been driven at very excessive rates, the efficiency of the heart has not been impaired by its Thirdly, the rate of auricular beating has fallen about increased energy expenditure. This fall might be attributed to lengthening of the circular 80 beats per minute. or more probably to its slower speed of movepath around which the wave travels, It would be interesting to know if lowering of rat.e is usual in auricular ment. flutter as age greatly advances. AUTHOR.
Ii.:
klin .A.Med
Precordial
Leads in Clinical
Electrocardiograms.
I)eutwhw
l\~~~l,.
I’.
179’ *, 1 IWC.
The author used two precordial regions for the exploring electrode ( thirtl inltbrspaw to the right of the sternum and the sixth interspace over the aprxj, his fiuwl electrode being the null point electrode of Wilson. Tile contour of the recwr~ls io 200 normal and cardiac patients is described. In left preponderance a flattt’nin;: of T was found in the apical lead; in righf preponderance a rernsal of alI tlltl complexes was found in the basal lead. This permitted him to distinq&h brtu-rcrr axis shift and preponderance. The value of thew leads in flutter and fihrillat,icm rlf the auricles is emphasized, and they show changes in S-T and T-naws early NIL al) normal hearts. I.. s. ii.
Spiihler,
0. :
Adams-Stokes
The author finds ventricular fibrillation
Syndrome.
that Adams-Stokes as by standstill
Ztwhr.
f.
ryndromr of the h~ri.
klin.
129: 693,
~1~1.
is c~;~urrtl
as often
by
1936.
tr:tnhilxllt
I,. N.
Marzahn, H. : Electrocardiographic 130’ * 1::5 1 193li.
Studies During
Work.
Ztwhr.
f.
klin.
Ii. ~1~~11.
\Vllen work caused an acceleration of the Iwart to 200 bwts twr miuutcx, the au1 1101 Fuuml that the QRIc span was shortenrd by 11.0 I swond. Estrasystoles temlwi IO appear, but extrasystoles present at rest tendfsll to disappear. So differenct. \viis noted in the appearance, disappearawe. and inagnitu~lr ~,f the wrdiac acceleration between normal and cwdiac patients. -In awPI~~r:lti
With Normal
The literature of recurrent complete heart-blwk :lltc~rn:tting with tion and accompanied by Adams-Stokes syndrome has born (wwlined L’O potential cases discovered in the literature, I:! have hren awepted with the criteria established. The important calinif+al, pathologiral, cardiographic data of these cases have been wtnrnariw~l.
normal von~ll~rcritically. Of as wrtlplyiog awl clwt re)-
.\ MW, a woman aged seventy-eight, with Mams-Stokes P,vwlrome, is prewLt+~ti in whit-h. as shown by electrocardiographic evidence, complete heart-block alternatfxd with normal rhythm and conduction. The results lvith atropine demonstratc~d that This case ultimatt:ly the cdhanges probably owurred independent of any vagus effect. Ilwelope~l a chronic complete block with the spontanr~w tlihappeararwe (II‘ thv s~ncop:~l attacks. The graplli(*
form of the transition from tracings, is summarized.
The practical phasized.
diagnostic
and
one degree
therapeutic
ot’ ~~on~lnction eonriderations
111 another. of thi,
3s rtrlwrl
Iaondition
IIF
are tw
374
THE
AMWICAN
HEART
JOURNAL
The pathogenesis of paroxysmal complete heart-block is discussed. It is probable that the majority of cases are on an arteriosclerotic basis and that either a fibrocalcareous mass or fibrosis due to coronary sclerosis partially damages the bundle of His. The fluctuating character of the conduction in these cases is probably determined by temporary variations in the local circulation to the remaining intact fibers. AUTHOR.
Grosse-Brockhoff, F., and Strotmann, Systole and the Electrocardiogram. The volume curves and optical anesthetized rabbits, simultaneously stant relation was found between systole. It was found that the mechanical systole, and the ratio the duration, let alone the power
Heim, F.: Med.
Conduction
98:
551,
A.:
The Time Relation Ztschr.
Between
f. d. ges. exper.
Med.
Mechanical 98:
227, 1936.
carotid artery pressure curves were recorded in with Lead I of the electrocardiogram. No conthe end of the T-wave and the end of the mechanical Q-T interval is not equal to the duration of the between the two is inconstant. One cannot judge of systole from the electrocardiogram. I,. N. K.
Disturbances
in Human
Heart.
Ztschr.
f. d. ges.
exper.
1936.
The relation of the P-R interval to the duration of the cycle is determined and shown to give a smooth curve. It is shown that the P-R interval does not lengthen as much as anticipated following interpolated auricular extrasystoles, presumably because the refractory period is shortened as the heart rate accelerates. The Wenckebach phenomenon in the digitalized heart with A-V block is attributed to progressive lengthening of the refractory period from beat to beat unt,il a ventricular beat is dropped and the refractory phase is shortened again. L. N. K.
Zlrday,
I. V.:
exper.
Med.
Electrocardiographic 98:
662,
Studies of the Auricles.
Ztschr. f. cl. ges.
1936.
The author used unipolar chest leads and could distinguish the action of each of the auricles. He demonstrated an asynchrony of 0.01 to 0.09 second between the onset of electrical activity in the two auricles. Leads I and III, according to the author, give only the P-wave of the left auricle, while the P-wave in Lead II is Splintering of P, is due to intera summation of the activity of the two auricles. aurieular block, and this block is the cause for a difference in t,he P-R interval in Leads I and II. (The interesting observations need confirmation.) L. N. K.
Lewis, J.
Auricular Thomas: 1: 1248, 1937.
Flutter
Continuing
for Twenty-Four
Years.
Brit.
M.
The case is of exceptional interest for three reasons. First, the auricles seem to have fluttered without cessation for twenty-four (if not twenty-seven) years. Secondly, although the ventricle during the greater part of the period has been driven at very excessive rates, the efficiency of the heart has not been impaired by its Thirdly, the rate of auricular beating has fallen about increased energy expenditure. This fall might be attributed to lengthening of the circular 80 beats per minute. or more probably to its slower speed of movepath around which the wave travels, It would be interesting to know if lowering of rat.e is usual in auricular ment. flutter as age greatly advances. AUTHOR.