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Article
June 1914

THREE CASES OF ADAMS-STOKES SYNDROME WITH HISTOLOGICAL FINDINGS

Arch Intern Med (Chic). 1914;XIII(6):957-969. doi:10.1001/archinte.1914.00070120119010
Abstract

Although it is established that a complete transverse lesion of the stem of the auriculoventricular conducting system or of its two main branches results in auriculoventricular dissociation, and although a few years ago the problem of heart-block seemed almost settled by the discovery of lesions in the conducting system, it is now apparent that the solution of this problem is not so simple as it appeared at that time. There are cases on record in which heart-block was proved beyond a doubt, but still no lesions in the hearts adequately explaining the failure of the conduction of impulses from auricle to ventricle were to be found.†

The three cases to be presented show three very different histological conditions in the conducting system; and it is somewhat unfortunate that the clinical data do not give us such definite information of the mechanism of the heart as can be positively

References
1.
Bishop:  Am. Jour. Med. Sc. , 1910, cxxxix, 62.Crossref
2.
Bishop and Larkin:  Proc. New York Path. Soc. , 1909, New Series IX, 58.
3.
In spite of the absolute break in the continuity of the right branch, impulses may yet have passed from the stump of the right limb through the ordinary ventricular musculature to the ventricular chamber, for it is not unlikely, judging by the anatomical findings in the hearts which we have studied and by physiological considerations, that the auriculoventricular system is not completely isolated between its two ends, namely, all along the line from the auriculonodal connection to the Purkinje fiber-ventricular junction.
4.
This may be due to the direction in which they are cut. It should be noted that in this (as well as in other hearts) some of the ordinary cardiac musculature seems paler or more vacuolated than the rest owing to the direction in which the muscle-fibers are cut.
5.
Such bundles of longitudinal smooth muscle-fibers are normally found in all hearts.
6.
Dr. A. E. Cohn in  Heart , 1912, iv, 24.
7.
In another heart (from a patient without data as to heart-block) though calcareous nodules were found grossly in the neighborhood of the bundle of His, microscopically these did not interfere with the continuity of the auriculoventricular system. This heart was kindly given us for examination by Dr. W. G. MacCallum.
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Armstrong and Mönckeberg:  Arch. f. klin. Med. , 1911, cii, 144.
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Sternberg:  Compt. rend. XVI Cong. internat. méd. , Budapest, 1909, Section VI, Méd. Interne, p. 396
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 Verhandl. d. XXIX Deutsch. Cong. f. inn. Med. , 1912, p. 444.
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MacCallum:  Johns Hopkins Hosp. Bull. , February, 1908, No. (203) , xix, 50.
12.
Marchand and Meyer:  Arch. f. d. ges. Physiol., (Pflueger's) , 1912, cxlv, 401.Crossref
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Nagayo [in  Beiter. z. path. Anat. u. z. allg. Path. (Ziegler's) 1909, xlv, 295]
14.
Cohn and Lewis:  Heart , 1912, iv, 24.
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