Synonyms.—Irregular Heart; Allorrhythmia; Delirium Cordis; Intermittent Heart.

Definition.—Arhythmia is a condition where there is either a drop, or skip in the beat—intermittent pulse; or where the volume or force of the pulse is not regular—irregular pulse.

Etiology.—The causes of arhythmia are many, and may act directly on the heart and its innervation, or indirectly, the irritation being at some distant part. Thus, of the first, disease of the heart and blood-vessels may be named. Pericarditis may so disturb cardiac innervation as to result in an irregular heart action; while an irregular or intermittent pulse may be the first symptom to direct our attention to myocarditis, either acute or chronic myocardial degenerations are often attended by arhythmia, though a morbid condition of the cardiac ganglia may not be detected.

Gouty subjects suffering with arteriosclerosis also frequently have an irregular pulse, while valvular lesions are common causes. Cardiac innervation may be disturbed by organic lesions of the brain, such as concussion, hemorrhage, meningitis, or growths, or physical influences, such as grief, fear, melancholy, etc.

Perhaps the most frequent causes are the reflexes, most prominent of which is dyspepsia, especially when flatulency is a prominent feature. Wrongs of the liver and intestines may also give rise to arhythmia. In late years the attention of the profession has been turned to wrongs of the genito-uterine and rectal systems as being responsible for irregular action of the heart. Laparotomies are not infrequently followed by arhythmia.

The toxic influence of tea, coffee, alcohol, and certain drugs, as well as the infectious fevers, may give rise to an irregular or intermittent pulse. The excessive use of tobacco, especially cigarette-smoking, is responsible for arhythmia, and is known as the tobacco heart.

Occasionally we meet with persons, apparently in good health, whose heart action is very irregular. Such a case I have in mind, the first knowledge of which was obtained during an examination for life insurance. That was some three or four years ago. I have examined the pulse and heart a number of times since, and always with the same result—arhythmia. The patient is the picture of health, and suffers no inconvenience from the trouble.

Figure 24. Examples of Arhythmia. Symptoms.—The irregularity may be in force, space, or time. The most common form is where an occasional beat is missed; it may be due to feeble ventricular contraction, the pulse-rate at the wrist being too weak to be perceptible. In other cases the intermission occurs with great regularity, each second, third, or fourth beat being absent. This pulse is known as the "pulsus bigeminous," "pulsus trigeminous," "pulsus quadrigeminous"

In the bigeminal pulse, the first beat is usually the stronger, and in some cases is the only one felt at the wrist.

The pulsus alternans is where every other beat is strong, followed by a weak one.

The paradoxic pulse of Kussmal is where the beats are more frequent and feeble during inspiration than during expiration.

Delirium cordis is where the pulse shows irregularity and inequality.

The fetal heart-rhythm, or embryocardia. is where the long pause is shortened, so that the first and second sounds are almost identical.

The canter or gallop rhythm is where, in a rapid pulse, the first, though more commonly the second sound, seems split, or a reduplication of the sounds. It has been likened to the triple sound of a horse at canter.

The arhythmia may impress the system so slightly that the condition is often discovered accidentally.

The diagnosis will be made by auscultation, at the same time the pulse is being taken at the wrist, or, what is better, by the use of the sphygmograph.

Prognosis.—The prognosis depends altogether upon the conditions giving rise to it. Many times the patient's health remains undisturbed for years, the arhythmia being discovered accidentally. When due to causes outside the heart, the prognosis is more favorable; but when due to valvular or myocardial changes, it is always more or less grave.

Treatment.—While the treatment depends upon the conditions found in each case, there are certain general instructions to be given in all cases, whether functional or structural.

Tea, coffee, alcohol, and tobacco are to be discontinued, the last two especially, while the former, if taken, should be used sparingly.

The diet is of importance. Only such food as is easily digested should be permitted, and all fluids at meal-times should be discontinued. Light exercise in the open air should be practiced daily, though, should there be structural wrongs, this should be carefully regulated.

Sexual excesses should be avoided, and all habits that produce exhaustion must be abandoned.

When the arhythmia is purely functional and due to reflexes, a thorough examination must be made to find the exciting cause.

Orificial surgery many times gives splendid results by removing exciting causes. If due to mental worry or overwork, a cure may be effected by change of occupation, change of climate, and change of scenes and mode of life.

Cactus.—Where the heart's action is feeble and the impulse at the wrist scarcely perceptible, cactus will give good results.

Veratrum.—Where the heart's action is wildly irregular and the pulse full, veratrum 10-15 drops, in half a glass of water, and a teaspoonful every one, two, or three hours, will be found beneficial.

Scutellaria is a useful remedy, where the irregularity depends upon undue nervous excitation. If there is tumultuous action it may be combined with macrotys or lobelia.

Crataegus.—This remedy helps steady the heart's action, whether the trouble is due to functional or structural wrongs.

Digitalis.—This old heart remedy would be used in similar conditions to those calling for cactus; viz., feebleness.

Strychnia.—When due to excessive venery or masturbation, strychnia, one-sixtieth grain three or four times per day, will give good results.

Macrotys, viburnum, and pulsatilla will be found useful when the irregularity is clue to uterine derangements.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.