Auricular Fibrillation Diagnosis


Categories: Uncategorized
Sources: Disturbances Of The Heart

If the pulse is intermittent and there is apparently a heart block.

Stokes-Adams disease should be considered as possibly present, and

digitalis would be contraindicated and would do harm.



A scientific indication as to whether a heart is disturbed through

the action of the vagi or whether the disturbance is due to muscle

degeneration may be obtained by the administration of atropin.

Talley [Footnote: Talley, James: Am. Jour. Med. Sc., October, 1912.]

of Philadelphia shows the diagnostic value of this drug. It is a

familiar physiologic fact that stimulation of the vagi slows the

heart or even stops it. Stimulation of these nerves by the electric

current, however, does not destroy the irritability of the heart;

indeed, the heart may act by local stimulation after it has been

stopped by pneumogastric stimulation. It is also a well known fact

that anything which inhibits or removes vagus control of the heart

allows the heart to become more rapid, since these nerves act as a

governor to the heart's contractions. Under the influence of atropin

the heart rate is increased by paralysis of the vagi. Talley states

that a hypodermic injection of from 1/50 to 1/25 grain of atropin

produces the same paralytic and rapid heart effect in man. He

advises the use of 1/25 grain of atropin in robust males, and 1/50

grain in females and in less robust males, and he has seen no

serious trouble occur from such injections. The throat is of course

dry, and the eyesight interfered with for a day or more, but Talley

has not seen even insomnia occur, to say nothing of nervous

excitation or delirium. Theoretically, however, before such atropin

dosage, an idiosyncrasy against belladonna should be determined.



The value of such an injection rests on the fact that atropin thus

injected will increase the normal heart from thirty to forty beats a

minute, and Talley believes that if the heart beat is increased only

twenty or less, if the patient has not been suffering from an

exhausting disease, it shows "a degenerative process in the cardiac

tissue which makes the outlook for improvement under treatment

unpromising." He also believes that when the heart in auricular

fibrillation is increased the normal amount or more than normal, the

prognosis is good. He still further advises in auricular

fibrillation an injection of atropin before digitalis has been

administered, and another after digitalis is thoroughly acting.

Comparison of the findings after these two injections will determine

which factor, vagal or cardiac tissue, is the greater in the

condition present. The patients with a large cardiac factor are the

ones who may be more improved by the digitalis treatment than those

in whom the fibrillation is caused by vagus disturbance.





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