Sources: Disturbances Of The Heart
Auricular fibrillation is at times apparently a clinical entity much
as is angina pectoris, but it is often a symptom of some other
condition. At times auricular fibrillation is only a passing
symptom, and is rapidly cured by treatment. A real auricular
fibrillation shows a semiparalysis of the auricles, and during this
condition normal systolic contractions do not occur, although there
are small rapid twitchings of different muscle fibers in the
auricles. Although it was once thought that the auricle was
paralyzed in this condition, it probably simply loses its coordinate
activity. Auricular fibrillation and auricular flutter are probably
simply different degrees of the same condition, and any contractions
of the auricles over 200 per minute may be termed an auricular
flutter, and below that the term auricular fibrillation may be used.
When ventricular fibrillation occurs, the condition is serious and
the prognosis bad. Both auricular fibrillation and auricular flutter
may be temporary or permanent, and the exact number of fibrillations
or tremblings of the auricular muscle can be noted only by
Tallman, [Footnote: Tallman: Northwest Med., May, 1916] after
examination of fifty-eight cases, classifies different types of
auricular flutter: (1) such a condition in an apparently normal
heart; (2) the condition occurring during chronic heart disease, and
(3) an auricular flutter with partial or complete heart block.
The irregular pulse in auricular fibrillation is more or less
distinctive, being generally rapid, from 110 upward. Occasionally
the pulse rate may be much slower, if the heart is under the
influence of digitalis. The irregularity of the pulse in this
condition is excessive; the rate, strength and apparent
intermittency during a half minute may not at all represent the
condition in the next half minute, or in the next several minutes.
If digitalis does not cure the irregularity, the condition has been
termed the "absolutely irregular heart." Other terms applied to the
condition have been "ventricular rhythm," "nodal rhythm" and "rhythm
of auricular paralysis." The condition of the pulse has been
Latinized as pulsus irregularis perpetuus.
While the condition is best diagnosed by tracings taken
simultaneously of the apex beat, jugular and radial, still the
jugular tracing is almost conclusive in the absence of the auricular
systolic wave. The radial tracing is exceedingly suggestive, and if
there is also a careful auscultation of the heart, a presumptive
diagnosis may be made.