. Transactions of the College of Physicians of Philadelphia . days later. Atautopsy in addition to cardiac hypertrophy anil dilatation ulcerationof the aortic valves was found. The following tracings illustrate most graphically the way inwhich digitalis improves the character of the pulse by suppressingthe extrasystoles, producing a longer diastole, a more complete 72 NORRIS: CAKDIAC ARRHYTHMIA period of rest, and resulting in a greatly improved state of the circu-lation. Fig. 7 was taken from a case of mitral stenosis and insuffi-ciency, with cardiac dilatation ;md tricuspid insufficiency. Th
. Transactions of the College of Physicians of Philadelphia . days later. Atautopsy in addition to cardiac hypertrophy anil dilatation ulcerationof the aortic valves was found. The following tracings illustrate most graphically the way inwhich digitalis improves the character of the pulse by suppressingthe extrasystoles, producing a longer diastole, a more complete 72 NORRIS: CAKDIAC ARRHYTHMIA period of rest, and resulting in a greatly improved state of the circu-lation. Fig. 7 was taken from a case of mitral stenosis and insuffi-ciency, with cardiac dilatation ;md tricuspid insufficiency. Therewas general anasarca, cyanosis, orthopncea with blood-tingedexpectoration, and a pulsating liver. The tracing shows the markedarrhythmia complicated by extrasystoles, and a positive venous patient was bled ten ounces and given three drams of theinfusion of digitalis thrice daily. A lew days later the general condi-tion was greatly improved. At this time the second tracing wastaken (Fig. 8), which shows a much slower, better filled and sustained. Fig. 7.—Double mitral disease with tricuspid insufficiency, showing extrasystolesand a positive venous pulse. radial pulse, and many fewer extrasystoles. It will be seen that thejugular pulse is still of the positive type resulting from the tricuspidleakage. The next type of pulse irregularity to which I would call atten-tion is a variety which is met with quite frequently in the advancedstages of heart disease, generally with failing compensation: 3. Perpetual Arrhythmia. Perpetual arrhythmia is one inwhich no regular rhythm whatever can be made out for long periodsof time—weeks or months. The subject of its etiology requiresfurther elucidation. When present in its typical form three charac- NoKKIS: (AHDIAC AKKIIYTIIM 1 A teristics are noted: (1) The jugular tracing shows no auricularwave; (2) it is always associated with a positive venous pulse; (3)absolutely no underlying rhythm can be detected. As to the secondquali
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