Auricular fibrillation and its relationship to clinical irregularity of the heart / by Thomas Lewis.

  • Lewis, Thomas, Sir, 1881-1945.
Date:
[1910?]
Catalogue details

Licence: In copyright

Credit: Auricular fibrillation and its relationship to clinical irregularity of the heart / by Thomas Lewis. Source: Wellcome Collection.

    11/80 (page 313)
    have been examined and the mechanism analysed in each case. These cases subdivide themselves as follows :— 1) Complete irregularity of the heart.. 57 2) Ventricular extrasystoles . . .. 34 3) Auricular extrasystoles . . ..11 4) Irregularity due to heart-block . . 3 5) Gross sinus irregularities . . . . 3 6) Complex irregularities and paroxysmal tachycardias . . . . . . . . 6 We see, therefore, that of 114 cases 57 were of the form under con- sideration, constituting 50 per cent, of the total number. With the exception of groups 4 and 6, the cases were in no way selected. All cases of persistent irregularity which have been observed during the course of my out-patient clinic at the City of London Hospital for Diseases of the Chest, and all cases of the same sort to which my attention has been directed amongst the indoor jiatients at University College Hospital have been included. Etiology {based vpon 73 cases). Of the sexes affected, 43 were males and 30 females. The age limits in this series are 13 to 84. The average age is 41-9 (67 cases). As regards the remaining etiological features examined, they are included in the accompanying table. It will be seen that a history of rheumatism* or chorea has been present in 26 cases ; in 3 additional cases at least there was a history of one or other in the family alone. Amongst the remainder mitral stenosis was present in 16, pericardial adhesions in one case, and subacute strejitococcic endocarditis in one case. Of 64 cases 29 were of undoubted rheumatic predisposition, or had actually suffered from joint affection or chorea. In addition, in 18 instances the rheumatic taint was open to suspicion. The total of 47 cases may be included in a rheumatic group, and for the most part these patients are amongst the youngest of the series. (The average age of 45 cases of the rheumatic group was 34-2 ; that of 22 cases of the non-rheumatic group 57-7.) 37 cases or 52 per cent, were instances of mitral stenosis, and the relationship to this form of valvulitis is so definite that additional figures relating to it may be given. In dealing specially with mitral stenosis I chose only those cases which came to my out-2)atient department, for the majority of the cases of mitral stenosis admitted to the * As a criterion of rheumatism I have taken a past diagnosis of rheumatic fever, or the history of an acute illness with swelling and pain in several joints.