. Clinical disorders of the heart beat : a handbook for practitioners and students . 0 and300 per minute there is as a rule little resemblance. Extremeacceleration of the auricle has its special characters, and thearbitrary line of separation is drawn at 200 per minute,because these special characters begin to appear when the 72 Chapter VI. rate is so far enhanced. Perhaps the most notable feature offlutter, or extreme acceleration of the auricle, is its almostinvariable association with heart-block. Flutter, so far aswe know, arises in the auricle only,* and the rate of theauricular contracti
. Clinical disorders of the heart beat : a handbook for practitioners and students . 0 and300 per minute there is as a rule little resemblance. Extremeacceleration of the auricle has its special characters, and thearbitrary line of separation is drawn at 200 per minute,because these special characters begin to appear when the 72 Chapter VI. rate is so far enhanced. Perhaps the most notable feature offlutter, or extreme acceleration of the auricle, is its almostinvariable association with heart-block. Flutter, so far aswe know, arises in the auricle only,* and the rate of theauricular contractions is so great, that the ventricle can rarelykeep the pace. The usual auricular rates are from 260 to320 per minute ; the systoles of the auricle follow each otherso rapidly that the diastoles are reduced almost to The usual ventricular rates are from 130 to 160,exactly half the auricular ; for 2 : 1 heart-block is generallypresent when the patient first comes under observation(Fig. 38). The new impulses which drive the auricles in this A iiiiiimimiiiiiiiiiiiiii. Fig. 38. A diagrammatic representation of auricular flutter. The abnormalauricular beats are broken in their centres. The auricular rate is veryrapid ; the ventricular rate is also rapid, but is half the auricular. 2 : 1heart-block is present. merciless fashion probably spring from a single focus in theauricular tissue, and as in the simple form of paroxysmaltachycardia, this focus is probably an unnatural one. Themischief lies at a distance from the pacemaker, and the reinsof control, the inhibitory nerves, are powerless. The auricle hasveritably seized the bit with its teeth. The ventricle, shielded * Ventricular flutter is unknown clinically ; it is probably unknownbecause, continuing, it would inevitably kill the subject of it. f These facts have been elucidated electrocardiographically. Auricular Flutter. 73 from the whip by the auriculo-ventricular bundle, lagsbehind. 2 : 1 heart-block is the ru
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