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January 1924


Author Affiliations


From the Medical Department, Western Reserve School of Medicine, Lakeside Hospital.

Arch Intern Med (Chic). 1924;33(1):1-22. doi:10.1001/archinte.1924.00110250004001

When the systemic arteriovenous circulation is short-circuited by a fistulous communication of sufficient size, symptoms develop so closely simulating those of myocardial decompensation that it may be difficult to evaluate the part contributed to the circulatory defect by the arteriovenous communication. In fact, the increased burden on the heart due to short-circuiting the flow of blood may in time produce genuine myocardial decompensation. The difficulties of diagnosis are still further complicated by the need of determining whether the arteriovenous communication is the sole cause of circulatory symptoms or only a contributory factor in the presence of cardiac disease. Obviously, if all the symptoms are due to arteriovenous fistula, the proper treatment is to close the opening. If the fistula is only a factor of minor importance, the operative procedure may be contraindicated. In the first case we have to report, the cardiac symptoms were so pronounced that a large number

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