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Synonym:—Irregularity in the pulsation of the heart.

Definition:—A condition in which the disordered nervous control of the heart induces irregularity of action, both in the time and character of the pulse beat. Intermittency of the heart's action refers to a condition in which, while the rhythm may not vary, there will be occasionally a regular loss of one or more beats. The lost beat may occur regularly on each alternating pulsation, or it may occur every third beat, or regularly every fourth, fifth or sixth beat. When many beats occur between the intermissions, there is apt to be variation of from one to four beats. It may occur at one time, on the twelfth stroke, the next time on the fourteenth, and the next time on the eleventh, and so on. This may be influenced by lying down, or by exertion, or upon forced rapidity of breathing. Irregularity of the intermission is not uncommon. Irregularity of the beats, without intermission, is often of no great importance; irregularity in the rhythm of the heart may not be at all serious in character.

Etiology:—The following classification of Baumgarten is the one now adopted by most writers: ist. Those due to causes situated in the nerve centers, either of a physical or mental character. 2nd. Reflex influences resulting from disease of the important organs of the body. 3rd. Those causes which are toxic in character, resulting from auto-toxaemia, or from the use of tea, coffee, alcohol and tobacco. 4th. Those resulting from disease of the heart itself. The first three of these are functional, although if persistently occurring, organic change may be induced in the heart by their presence. The last, of course, is organic. The symptoms of irregularity of the action of the heart are not always conspicuous and are often considered of no importance. There may be no impression whatever upon the patient's health, the irregularity being so mild as to no way influence the function of any organ. If, however, the irregularity be accompanied with palpitation, the influence upon the patient may be very conspicuous, and often apparently serious.

Diagnosis:—This depends upon the presence or absence of organic heart change. Palpation and auscultation will assist in determining the presence of chronic conditions as a cause of the irregularity. A thorough examination of the condition of the patient's system must be made in order to determine the presence of reflex causes, or those of cerebral origin. All possible causes of the condition must be thoroughly considered.

Treatment:—The first consideration in the treatment is the removal of the cause. In fact, but little can be done in regulating the action of the heart unless the cause is removed. We would, therefore, refer the reader to the consideration of the treatment of the diseases which act as causes of this irregularity. One of the commonest causes in young men is the use of cigarettes, from which arhythmia, with mild palpitation and pronounced cardiac weakness will soon result. The importance of discarding tobacco, tea, coffee and alcohol in these cases, cannot be too greatly emphasized. Disorders of digestion are common causes and these should have treatment directed to their removal. I have observed, however, that cactus given with hydrastis will remove the larger proportion of these cases, provided there is no exaltation of nerve force, but when from this cause there is irritability of the action of the heart, it is desirable to use gelsemium, or a bromid, with hydrastis, or other properly adjusted stomach tonic The bromide of strontium is a remedy of excellent service in its influence upon the central nervous system and upon the heart, when gastric disturbances induce the irritation. The use of small doses of nux vomica or of the strychnin arsenate, or zinc valerianate, will be found of service in carefully selected cases.

There are times when the irregularity seems threatening in its character, in which case a remedy directed through its stimulating influence upon the heart's action to the condition in hand must be selected. I have found some cases to be relieved quickly and satisfactorily by the use of a mild direct stimulant to the stomach. Capsicum, ginger or peppermint, with or without the use of eupatorium, have often exercised a prompt and very satisfactory influence in cases of abrupt occurrence. I have obtained benefit from the action of an alkaline remedy continued for some little time, when such a remedy was indicated, and have been impressed with the necessity of eliminating the urates and other causes of autotoxemia. A saline laxative, which will act without irritation, is of benefit occasionally.

The Eclectic Practice of Medicine with especial reference to the Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.

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