On two heart cases which presented a rare form of irregularity : from Dr. G.W. Balfour's "Clinique" / by Charles S. Roy.

Date:
1878
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Licence: Public Domain Mark

Credit: On two heart cases which presented a rare form of irregularity : from Dr. G.W. Balfour's "Clinique" / by Charles S. Roy. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    the former case first showed itself. It came with the same suddenness, and resembled in detail so closely that presented by Beatrice Matherson, that I need not enter into the details for a second time. The sphygmograms A and B show the usual pulse, and that when the irregularity was present, while the cardiograms C and D show the corresponding change in the heart-beat. In E the pulsation of the jugular bulb is seen. It is noted that the irregularity in this case came and went without apparent cause, nor was it possible to produce it here by pressure over the carotid of either side, though here also pressure on the left carotid caused unusual pain. Patient also occasionally suffered from hypermsthesia of the skin of the chest, and to a lesser degree of that of the limbs. Twice she suffered from uncontrollable vomiting', lasting- several hours. The ever-recurring embolisms gradually reduced the patient to the last extreme of misery, from which she was relieved by death on 29th April 1876. Post-mortem.—I give Dr Wyllie’s report, as far as concerns the heart, in full. “ Heart enlarged, weighing 1 lb. 2\ oz. Right auricle and ventricle were much dilated, and the tricuspid orifice was en- larged, admitting eight fingers. The auricular appendix wasfilled with a thrombus, which was evidently somewhat old. It was adherent at its periphery to the endocardium, and its centre was partially reduced to a soft yellow pulp by fatty degeneration. The visceral pericardium covering the appendix was white and opaque from chronic inflammatory thickening. The left auricle and ventricle were considerably dilated. The muscular wall of the ventricle was slightly hypertrophied, measuring f inches in thickness. In the auricular appendix of the left auricle were several small gray thrombi about the size of peas. In the cavity of the ventricle there were also a number of thrombi, and two of them ot large size, being respectively that of a walnut and of a filbert. These were of a dirty-gray colour and firm consistence. They presented a reticu- lated arrangement, rather delicate, of the fibrin superficially, and, on being cut into, the larger of the two was found to present a collection of fatty matter in its centre near one extremity, and a serous cyst near the other. The mitral orifice admitted four fingers; cone diameter, 1‘55 inch. The mitral and aortic valves presented atheromatous thickening, but otherwise natural.” Lungs.—Pleuritic adhesions on both sides. Fibroid induration of posterior and lower half of right lung. At upper part of indurated portion a wedge-shaped embolic infarction. Left Lxmg.—In inferior lobe, a large recent pulmonary apoplexy. Spleen and kidneys presented each several cicatrices of embolic processes. The clearness and sharpness of the signs presented by these two cases, together with the fact that other well-authenticated cases are to be found in medical literature, render it superfluous for me to use arguments to prove that this form of irregularity can only be explained by a more or less independent action of the two ventricles.