Auricular Fibrillation Auricular Flutter

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

electrical instruments.

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.

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