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"In what is termed nodal rhythm, the stimulus for contraction arises in some part of the auriculoventricular junctional tissues, giv- ing rise to simultaneous contraction of both auricle and ventricle. J" PRICE: AURICULAR FIBRILLATIOX. 731 The tendency to occurrence increases, however, until finally the condition usually becomes permanent. EFFECT OF AURICULAR FIBRILLATIOX ON THE HEART. The effect of auricular fibrillation on the heart's action is usually pronounced. Instead of the ven- tricle receiving stimuli from the auricle at regular ii»it«tt«»«* » > " »***'*'*''*''* " '*'' " *'***'*''*' " ' AJ\jvJVJV.Jv.AjuVjWavJ^J^ — Tracing of the radial pulse irregularity Diamox Tablets of the pulse. rvnn/"">^Tr"»~»~« showing /'XA^-^i*V%V' intervals, it receives them at completely irregular intervals. Further, die impulses which escape are numerous, and, if the conducting tissues are able to transmit them, the ventricular rate rises. Thus, an irregular, and, Order Diamox in the large majority Buy Diamox of cases, a much too frequent Diamox Mg pulse is produced. Such a change in the action of the ventricle, as a rule, produces a decided effect on the heart's efficiency. ETIOLOGY. The majority of cases of auricular fibrillation falls within two groups: 1, those with a history of rheu- matism, and, 2, patients suffering from myocardial degeneration. In the case of the for- mer, the condition occurs more com- monly in early adult life, and the pa- tients frequently have valvular disease — more often mitral than aortic disease, and more especially mitral stenosis. In the second group of cases, Purchase Diamox Online the condition is more Generic Diamox common after middle age. Auri- cular fibrillation has also been found occasionally in pneumonia, diphtheria, infective endocarditis, and the terminal stages of various exhausting diseases. Full doses of digitalis may produce it in predisposed cases, but only rarely. It is occasionally noted in Order Diamox Online aged people who exhibit no other symptoms or signs referable to the heart, so long as the pulse rate does not exceed the normal for their age. Its onset can now and again be traced to bodily effort, espe- cially in the niiddleaged or elderly. subjective symptoms. Acetazolamide Diamox But, when the ventricular rate is much above the normal, symptoms as a rule are present, and these are the same as those of car- diac failure from other causes, such as shortness of breath, a sense of exhaustion, cyanosis, and dropsy. It would appear, however, that patients suft'ering from auricular fibrillation rarely suffer """'" from definite attacks of angina pec- toris. Iv Diamox When the pulse rate is very slow, the Adams-Stokes syndrome may Buy Cheap Diamox be present. The degree of cardiac failure Diamox 125 Mg Diamox 500mg which arises as a result of auricular fibrilla- tion may Tablet Diamox be slight or very severe. It depends upon, Diamox Generic a, the rate of the ventri- cular action and, b, the degree Purchase Diamox of inher- ent nuiscle Diamox 500 defect. As a rule, the onset of symptoms is gradual, but may Diamox Buy ensue rapidly and the patient becomes very ill within a few hours. Similarly, the ces- sation of auricular fibrillation may be accompanied by an equally rapid im- provement in the patient's condition. The character of the pulse is very important. There is a wide variation in the ventricular rate, according as the patliway for impulses to the ventricle is free or interfered with, ranging from 40 to 140 or even 180 a minute, the average rate l^eing between 90 and 140. The rate of the radial pulse does not necessarily represent the ventricular Diamox Sequels 500 Mg rate, for many beats of the heart may not be transmitted to the wrist, especially when the ventricle is beating rapidly ; the ventricular rate, therefore, should be counted at the apex, either by palpation or prefer- ably by auscultation. The pulse in auricular fibrilla- tion is irregular, the irregularity in the Diamox Acetazolamide majority of

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