A historic instance of the Adams-Stokes Syndrome due to heart-block / by G. A. Gibson and W. T. Ritchie.

Date:
1909
Catalogue details

Licence: In copyright

Credit: A historic instance of the Adams-Stokes Syndrome due to heart-block / by G. A. Gibson and W. T. Ritchie. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    depth, and 5 cm. in width. It was thickened, particularly at its basal part, where it was also of yellowish colour, opaque, and firm. This increased thickness was derived in part from the attach- ments of the chordre tendinete radiating to the back of the valve. On microscopic examination of the basal part of the cusp, numerous fine calcareous deposits were detected. The posterior or marginal segment was also thickened. It was 6‘5 cm. wide, and was never more than 17 cm. deep. The chordae tendineae attached to the edge of the valve segments measured from 24 to 2'6 cm. in length, but those passing to the extreme tip of the papillary muscles averaged only 1'8 mm. in length. All the chordae tendineae were thickened, though not markedly so, but none were shortened. The fibrous change I extended from the chordae tendineae into the tips of the papillary muscles. One of the chordae passing from the posterior papillary muscle to the right margin of the posterior cusp presented, in its upper half, a club-shaped enlargement 4 mm. thick, which, when incised, was found to be composed of fibrous tissue. Several small pouches projected on the auricular surface of the posterior cusp. A small yellowish-bi’own opaque nodule, 1 mm. in diameter, which was attached to the auricular surface of the posterior cusp at the junction of its anterior and middle thirds and midway between its base and free margin, was evidently a partially organised vegetation. With this exception, there was no sign of recent endocarditis at any of the valvular orifices of the heart. The mural endocardium presented patchy thickenings.. On some of the columnae carnese these thickenings were represented by greyish-white fibrous areas lying with their long axes parallel V to those of the column® came®. Several thin greyish-white fibrous II cords passed between adjacent column®. The length of the left ventricular cavity along its septal wall f was 95 mm.; along its lateral wall 100 mm. The ventricular wall I was, in general, hypertrophied. At the extreme apex the wall was, i indeed, only 4 mm. thick, but at the level of the base of the anterior I papillary muscle it was 1-7 cm. thick, and at a point 1‘5 cm. below I the auriculo-ventricular junction the thickness of the wall was 2 cm. On the cut surface of the ventricular wall numerous pale ■ greyish streaks and patches were observed, indicating' fibrous I transformation of the myocardium. These patches were most j evident in the anterior papillary muscle (see Plate IV. Fig. 2) land in the myocardium in its vicinity. The branches of the jcoronary arteries which pass downwards and likewise those passing