. Diseases of the heart and thoracic aorta. balance ofthe heart is deranged, and the pulse-rate increased. In ai&\N cases (as for instance, in exophthalmic goitre in which thesympathetic is irritated, and in the later stages of basilarmeningitis, in which there is probably paralysis of the vagus),the nerve derangement depends upon organic disease ; butin the large majority of cases, as in hysteria, in which affec-tion the pulse frequency may be enormously increased, thecondition is a functional one. 4. Some cases of organic cardiac disease, especially mitralregurgitation (see fig. 104), and (t
. Diseases of the heart and thoracic aorta. balance ofthe heart is deranged, and the pulse-rate increased. In ai&\N cases (as for instance, in exophthalmic goitre in which thesympathetic is irritated, and in the later stages of basilarmeningitis, in which there is probably paralysis of the vagus),the nerve derangement depends upon organic disease ; butin the large majority of cases, as in hysteria, in which affec-tion the pulse frequency may be enormously increased, thecondition is a functional one. 4. Some cases of organic cardiac disease, especially mitralregurgitation (see fig. 104), and (to a less extent) in aorticregurgitation (see fig. 105). Pressure 3 oz. Fig, 104.—Mitral Regurgitation.—M. A. C, £et. 16, admitted to Newcastle In-firmary 24th January 1878, suffering from cough and shortness of breath,dating from an attack of rheumatic fever two months previously. Heartsaction very rapid (120-130). The first sound appeared to be reduplicated ;a systolic murmur was audible at the apex when the heart became Fig. 105.—Pulse tracing from a Case of Aortic Regurgitation, The Clinical Significance of Increased Frequency of the Pulse. Increased frequency of the pulse, when not merely tem-porary, is very suggestive of pyrexia ; it is, however, per se,an unreliable sign of fever, for, on the one hand, fever may bepresent without any increase (a diminished pulse-rate being,as I have already pointed out, sometimes met with, as in theearlier stages of typhoid and in meningitis); and, on theother, increased frequency of the pulse may occur without 266 Diseases of the Heait. fever, or even with a low temperature, as in pro-agonisticcollapse. In order to ascertain the cause of the increasedfrequency of the pulse, the first step is to take the tempera-ture. If there is no pyrexia, the causes mentioned underheads 2, 3, 4 must be looked for. A slow pulse may be due to— 1. Fitnctional derangement of the heart.—This is pro-bably the cause of the slow pulse which
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectheart, bookyear1884
