Archives of internal medicine (Chicago, Ill. : 1908)
Of the recognized disorders of the cardiac mechanism, none possess greater interest than the paroxysmal tachycardias. This affection has been recognized as a clinical entity for more than thirty years, and the condition has been produced experimentally by various means. Two questions have recently been revived; one, concerning sites of origin, especially the possibility of a paroxysm arising at the sinoatrial node (nomotopic tachycardia) and the other, concerning the r\l=o^\leof the extrinsic
... eof the extrinsic nerves of the heart. Herewith I wish to report six cases 1 of paroxysmal tachycardia which illustrate the moot points and the variety of clinical conditions in which the disorder occurs. REPORT OF CASES Case 1.\p=m-\J.W., aged 19 years, student. This patient was first seen Dec. 30, 1919, when he came for examination because of unduly rapid and forceful heart action which frequently occurred following exercise. He says they have been present as long as he can remember, and his mother recalls attacks as early as 5 years when the child often ran to her, frightened because of the abnormal cardiac activity. An aunt has told him that when he was a small boy she had noticed that his heart was extremely rapid when at play. Rarely, pounding of the heart is experienced at night but usually there is no consciousness of the heart except during the attacks. The paroxysms are often related to exercise but from consideration of many attacks it is clear that they are not dependent on the total energy expended but rather follow sudden or spasmodic effort. Attacks have occurred irregularly during gymnasium exercises, following cer¬ tain maneuvers in military drill, swimming, especially just after plunging into cold water, after a sudden spurt for a car or coughing. But in carefully planned gymnasium work and hard labor in the hay field during the summer the pulse rate does not rise above 80. At the laboratory attacks have followed running up and down stairs but at other times this exercise or hopping until dyspnea necessitated rest did not bring on a paroxysm. The emotional factor is seen in the occurrence of paroxysms while dancing and while watching an exciting football match. These attacks always begin suddenly and cease abruptly; according to the patient, "it is just like shifting gears on a car." The duration is from a few minutes to two hours. He thinks he often stops an attack by holding his breath or throwing himself suddenly across a bed or convenient object, and says that recently an attack ceased promptly after pressure on the right eyeball. During the attack the heart beats rapidly and From the Electrocardiographic Laboratory of Mercy Hospital. 1. These patients were referred by Drs. J. A. Lichty (Cases 1, 4 and 5). E. M. Frost (Case 2), J. I. Johnston (Case 3), and G. L. Hays (Case 6), to whom I express my indebtedness.