The query corner

The @lery

Corner

are invited to submit queries on all aspects of cardiovascular diseases. Insofar as possible these will be answered in this column by competent authorities. The replies will not necessarily represent the opinions of the American, College of Cardiology, this Journal or any medical organization or group, unless stated. Anonymous communications and queries on postcards will not be answered. Every letter must contain the writer’s name and address, but these will not be published.

R

EADE:RS

Auricular Fibrillation and Digitalis Query: I recently saw two patients rapid

~~~~~~a~~~~with

min> of recent origin.

ve~tri~lar

with auricuZar

rate

( 120- 130/-

There were no signs or symp-

tams suggestive of eit.her mitral stenosis or hyperthyroidism. &bed

to arteriosclerotic

but slights

enlarged

other patient, the “idiopathic

heart disease.

digitoxin.

With

the above

it would seem that further

time.

it seemed impossible

(i.e.,

to in-

reducing

would not be pos-

at conversion

might be

If the rate of 90 at rest is also present it would seem that the patient

having

A helpful

adequate article

ventricular

is

filling

in this field is that by

J. A. M. A. 166: 2139, 1958.

C%aigetal.

3% GREY DIMOND, M.D.

second patient up to 0.3 mg of digitoxin a day for four weeks)

mentioned

full digitalization

rate with digitalis

the

have had ex-

toxication)

probably

(in the

whether

might

and

with activity,

In the

bed rest and full digitalization

cessive

wonder

conditions

indicated.

aged 32, theJTbrillation seemed to be of The heart size was normal. variety.”

Despite co@lete

I would mentioned

sible and that an attempt

could be asThe heart was

on x-ray examination.

of His. patient

the heart

Congestive failure was absent in both.

In one patient, agea’ 54, theJibrillation

bundle second

Kansas City, Kansas

to reduce the ventricular

rate at rest to below Q&tper min. What can be done in such cases to further reduce the heart rate with

digitalis?

treat that particular

Most

$roblem

textbooks

of mitral

stenosis

Query:

of auricular fibrillation

with rapid ventricular rate, resistant to digitalis absence

Anticoagulants in Pericarditis

do not

or hypothyroidism.

if this is true, the reduction

anticoagulant

of rate to approximately 90 seems a fairly adeIt is not uncommon for a quate response. maintain

to fibrillate

the use of digitalis.

drome

some disease

of the conduction

amount

of

digitalization

syndrome

to

treated

and

and

of gen-

therapy, particularly The has been with

who

pericarditis did

receive

postmyocardial observed

anticoagulants

783

synanti-

those who were given infarction

both and

in patients

in those

treated. There is apparently no causal tionship between anticoagulant therapy development of the syndrome.

digitalis intoxication can occur with rapid rate since digitalis effect is produced by depression of conduction through the A-V node and the

DECEMBER, 1958

in the presence

Has the postinfurction

Answer :

system.

necessary

therapy

been seen in jratients

coagulant heparin?

onset it may in-

The slowing of heart rate is not proportional the

Query:

to

In fact, if a patient is fibrilrecent

were reported,

eralized pericarditis.

a rate slightly above normal even with

lating slowly following dicate

begun

deaths

one fatality was observed by this consultant, caused by hemopericardium as an effect of

I assume that the apical rate of 120

person who has recently

increase

hollowing acute myocardial infar&tio~~ Answer : Several

to 130 was at rest;

that anticoagulants

the risk of -hemorrhage in the presence of pericarditis

in the Are

these cases frequent? Answer:

Do you feel

not relaand