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Updated: June 24, 2025
The patient must avoid wearing anything, such as a garter, which constricts the limb, and any obvious cause of direct pressure on the pelvic veins, such as a tumour, persistent constipation, or an ill-fitting truss, should be removed. Cardiac, renal, or pulmonary causes of venous congestion must also be treated, and the functions of the liver regulated.
The face is pale, the eyes show fear, and the whole expression is almost typical of cardiac anxiety. The patient feels that he is about to die. The pulse is generally slowed, may be irregular, and may not be felt at the wrist. The blood pressure has been found at times to be increased.
Tapping's monde, preoccupied by a flavour of chandled tallow, to a halo of pomatum. Mrs. Riley was also unchanged; she, however, had no alarming cardiac symptoms to record. But as to that turn Dave Wardle giv' Mrs. Tapping. It really sent your flesh through your bones, all on edge like, to see a child fly up in the air like that.
If it occurs later in life it generally is associated with aortic narrowing, and is a part of the general endarteritis and perhaps atheroma of the aorta. Sometimes it is caused by strenuous exertion apparently rupturing the valve. This form of valvular disease frequently ends in sudden death. On the other hand, it is astonishing how active a person may be with this really terrible cardiac defect.
A sudden convulsive effort of the fish enabled it to enter the fisherman's throat, and he was asphyxiated before his boat reached the shore. After death the fish was found in the cardiac end of the stomach. There is another case of a man named Durand, who held a mullet between his teeth while rebaiting his hook.
It has now been known for some time that the primary stimulus of cardiac contraction generally occurs at the upper part of the right auricle, near its junction with the superior vena cava, and that this region may be the "timer" of the heart. This is called the sinus node, or the sino-auricular node, and consists of a small bundle of fibers resembling muscle tissue.
Other very important factors in causing the varied fortes of cardiac disturbances are the rapidity and strenuousness of a business and social life, and competitive athletics in school and college, to say nothing of the oversmoking and excessive dancing of many.
It may be taken for granted, however, that hardly any serious illness can long continue without cardiac muscle disturbance. If endocarditis is present, soft systolic murmurs soon appear. With the acute myocarditis developing, the apex beat is less positive, less accentuated, and later it becomes diffuse and even feeble.
To understand the phenomena of this disease, it will be well to refer to the first chapter of this book. Until 1893, when His described the bundle of muscle fibers which is now known by his name, the transmission of the cardiac stimulus to contraction was not understood.
The patient in shock has low temperature, low blood pressure, and a pulse either rapid or slow, but excessively feeble; the face is pale, the surface of the body cold, and there is more or less clammy perspiration; there may be dyspnea and cardiac anxiety, or the patient may hardly breathe. An acute cause, as terrible pain or hemorrhage, must of course be stopped immediately.
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