A historic instance of the Adams-Stokes Syndrome due to heart-block / by G. A. Gibson and W. T. Ritchie.

Date:
1909
Catalogue details

Licence: In copyright

Credit: A historic instance of the Adams-Stokes Syndrome due to heart-block / by G. A. Gibson and W. T. Ritchie. 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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    In the earlier sections from this block, which was cut in the horizontal plane, the auricular septum was found to contain much adipose tissue. The auricular muscle fibres were hypertrophied, but otherwise healthy. The aortic cusp of the mitral valve (see Plate VII. Pig. 1) was dense and fibrous, and contained numerous small calcareous deposits. In subsequent sections, passing lower down towards the line of attachment of the septal cusp of the tricuspid valve, the fibrous change spreads from the mitral valve into the auricular septum, and there is much calcareous deposit in the dense fibrous tissue. In Plate VII. Pig. 3 we observe how dense is the fibrous transformation. It is here that the auriculo- ventricular node and first part of the bundle are involved by the fibrosis and calcification. The condition is depicted in the photo- micrograph in Plate IX. Pig. 1, and in the coloured illustration in Plate X. Both the fibrosis and the calcification Vere extremely pronounced, and just as aiiriculo-ventricular dissociation may be induced by a complete section of the bundle or by the application of a clamp thereto, so, in our opinion, tliere is no doubt that the structural changes which we have described in the auriculo- ventricular bundle were amply sufficient to constitute an impass- able barrier to the transmission of stimuli from auricle to venti’icle. The I’urkinje fibres were found to be perfectly normal, and np evidence of disease was observed in the vagus nerves. The tissues at the junction of the superior vena cava and the right auricle presented no abnormality beyond the fact of there being a considerable increase of adipose tissue in this region. Before concluding, we may refer very briefly to the conditions observed in other instances of heart-block. The earlier cases have already been discussed by us in a previous communication^ in 1907. Since then, A. G. Gibson^ has collected thirteen cases froin the literature. He adds another which he himself examined; and in collaboration with TurrelB he has recorded yet another case. Lewis^ collected records of twenty-seven cases, but after analysing them he concludes that in only seven was both the clinical and the histological evidence fully satisfactory. Xagayo® has still more recently analysed the literature of the subject. 1 T]ie Practitioner, 1907, vol. Ixxviii. 589. ^ QvMrterly Journal of Medicine, 1908, vol. i. p. 182. ® British Medical Journal, 1908, vol. ii. p. 1486. ^ Ibid., 1908, vol. ii. p. 1798. ' ® Zeitschrift fur Jdinische Medizin, 1909, Bd. Ixvii. S. 495. ,i.