. Medical diagnosis for the student and practitioner. eceding thec wave normally by ^ of a second or less. 3. Determine the v waves. These are normally the only remainingwaves of importance and lie approximately midway between the cwave and the a wave of the following heart cycle. 4. Determine the nature of extrasystoles if they occur. (Detailed descrip-tion to be given later.) 5. If the a wave is absent look first for the presence of fibrillation and,if found, label the fibrillatory waves f, f, 1 6. Determine the rhythm. With the presence of extrasystoles or fibrilla-tion the arrhythmia itsel
. Medical diagnosis for the student and practitioner. eceding thec wave normally by ^ of a second or less. 3. Determine the v waves. These are normally the only remainingwaves of importance and lie approximately midway between the cwave and the a wave of the following heart cycle. 4. Determine the nature of extrasystoles if they occur. (Detailed descrip-tion to be given later.) 5. If the a wave is absent look first for the presence of fibrillation and,if found, label the fibrillatory waves f, f, 1 6. Determine the rhythm. With the presence of extrasystoles or fibrilla-tion the arrhythmia itself is apparent at a glance. To determine sinusarrhythmia measure the distance between the tops of any two radial thrustsand make comparison with several other similar intervals. A variation inthese intervals, in a record otherwise normal, indicates sinus arrhythmia inits varying degrees. The pulse rate is markedly affected by respiration,being increased by full inspiration, and decreased by full expiration. It iswholly abolished by vigorous Fig. 197.—This record shows an extrasystole of auricular origin at a-c. There is nocompensatory pause. In this patient the conduction of the premature stimulus is undulydelayed, the a-c interval being almost two-fifths of a second. The diagram shows therelative incidence of the systoles of the auricles and ventricles. {After John Hay.) 7. Determine the a-c interval. Lay off the distance from thebeginning of the a wave to the beginning of the c wave. Comparethis with the time-record. The normal does not exceed sec. 8. Determine the rate. The time is recorded by the marker in fifthsof^a second. Fifteen spaces on the time-record is equivalent therefore to3 seconds. From the top of one of the radial thrusts lay off a 3-secondinterval (15 spaces on the time-record) and count the radial thrusts duringthat period; then lay off another consecutive distance of 3 seconds andcontinue the count. The result is the number of heart cycles
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