ELECTROCARDIOGRAPHIC STUDIES OF THE DYING HEART IN ANGINA PECTORIS

R L Hamilton, H Robertson
1933 Canadian Medical Association Journal  
ELECTROCARDIOGRAMS taken during attacks of angina pectoris are relatively rare, and tracings of the dying heart during one of these attacks extremely rare. The author wishes to report electrocardiographic observations of a heart before, during, and after a fatal attack of angina pectoris. Such a report has not hitherto been published. The interest of this report is enhanced by the fact that it was possible te correlate certain physical findilngs with those of the electrocardiograms of the dying
more » ... heart. The various physiological changes which took place in this dying heart are also of definite interest. The diagnosis of angina pectoris was confirmed by autopsy. Electrocardiographic studies of angina peetoris, particularly those of Fogelson and Willius, have shown that the cessation of cardiac function is not simultaneous with clinical death. Further, the process of the dying of the heart is not identical in all cases. In the case reported here, clinical death was evident before complete cessation of the myocardial contractions. Whether or not the heart sounds are demonstrable during ventricular fibrillation has been of interest to many cardiologists. In this instance, heart sounds were demonstrable for at least three minutes following ventricular fibrillation. The general changes which took place in the electrocardiogram at the very beginning of the attack could not be demonstrated, as the attack had started before it was possible to get the electrodes applied and the machine started. The electrocardiographic findings during this first attack were the development of an auricular fibrillation, more inversion of the T waves, and frequent premature ventricular systoles arising apparently from the same focus. Q.R.S. complexes become notched, the Q.S. interval markedly widened, and an impure auricular flutter was noted momentarily. The premature ventricular systoles then became more frequent and variable in their place of origin. The attack subsided, but the electrocardiogram did not return to normal. The auricular fibrillation persisted, the premature ventricular systoles were very frequent (arising from multiple foci), and the Q.S. interval very markedly increased.. There was also a coarse somatic tremor demonstrable. A bradyeardia developed; the rate was 43. The ventricular rhythm was more regular. Suddenly a second attack started, and by the time the electrocardiogram could be taken, the heart was in ventricular fibrillation. The ventricular waves gradually became smaller in amplitude and more rounded until almost a straight line was recorded. This line suddenly dropped below the iso-electric level, after which no auricular or ventricular complexes were demonstrable. A number of the smaller waves seen on the electrocardiogram, and believed to be ventricular in origin may have been due to certain electrical changes which were taking place in the body generally. CASE REPORT The man, a machinist 49 years old, was admitted to the Robert Packer Hospital on June 1, 1930. He complained of belching of gas, shortness of breath on exertion, and attacks of epigastric distress. During the preceding two years he had noticed some slight dyspna-a on exertion, and had been subject to attacks of epigastric distress which did not necessarily follow exertion or food, and had occasional spells of regurgitation of sour material from his stomach. He felt as if the upper abdomen were bloated and filled with gas, and because of this, breathing was slightly difficult. For relief, he had used alkalies, ginger and whiskey. Occasionally he would belch gas, then feel more comfortable. On several occasions he had vomited during the attacks. He described the latter attacks as rather suffocating in nature, and he had become apprehensive for his safety during the attacks. In one of the later attacks, his attending physician was called to see him, and believing it to be a gallbladder attack, administered a hypodermic. These attacks lasted from five to thirty minutes, and became more frequent and severe. Although exertion had contributed to a number of the more recent attacks, several occurred during the night, and a number also while the patient was sitting quietly. There was occasional nocturia.
pmid:20319191 pmcid:PMC402956 fatcat:xaztk67bdnexjo4zo2ybacgo7e