. The diseases of infancy and childhood : designed for the use of students and practitioners of medicine. anced cardiac disease of childhood to warrant mentionhere. It may occur in badly damaged rheumatic hearts, both in mitraland aortic disease. Hearts with pericardial adhesion may show fibrilla-tion. It is seen only in advanced forms of so-called stenosis may exhibit this disturbance of function to an exquisitedegree. In addition to the valvular lesion the structural changes inmuscular tissue including dilatation and hypertrophy with myocardialchanges may be ad\anced. T
. The diseases of infancy and childhood : designed for the use of students and practitioners of medicine. anced cardiac disease of childhood to warrant mentionhere. It may occur in badly damaged rheumatic hearts, both in mitraland aortic disease. Hearts with pericardial adhesion may show fibrilla-tion. It is seen only in advanced forms of so-called stenosis may exhibit this disturbance of function to an exquisitedegree. In addition to the valvular lesion the structural changes inmuscular tissue including dilatation and hypertrophy with myocardialchanges may be ad\anced. The pulse may be rapid (120 to 160 beats),some strong, others weak, with an irregularity and characteristic dis- DISEASES OF THE HEART 687 order. In the slower pulse there is a marked irregularity. The heartsounds vary in intensity at the apex. Symptoms of Fibrillation.—Fibrillation may be suspected if in addi-tion to diastolic murmurs at the apex drawn to the end of diastoleof the auricle there is persistent irregularity of pulse, cyanosis, ordyspnea, anasarca, and all the signs of cardiac Fig. 189.—Electrocardiogram. Chronic endocarditis, presystolic and systolic mitral murmur. Auricular fibrillation, absence of /-waves, irregularity of rhythm and oscillatory waves during diastole. Right ventricular predominance. Boy, twelve yearsof age. Diagnosis.—The diagnosis rests on the recognition of a mitralstenotic lesion accompanied by a regurgitant murmur with a diastolicmurmur at the apex occupying the whole of diastole and apt to bemistaken for an aortic regtn-gitation. Lewis insists tliat aortic regurgi- 688 DISEASES OF THE CIRCULATORY SYSTEM tation pure and simple with fibrillation is rare, though I have met it mundoubted cases of aortic lesions. Treatment.—It is in these cases of mitral disease with fibrillation thatdigitalis attains its greatest utility. It should be pushed and watched,the pulse rate as it begins to fall and the heart becoming more regularare
Size: 1447px × 1727px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1910, bookpublish, booksubjectchildren
