Three Cases of Adams-Stokes Syndrome With Histological Findings

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 discov- ery of lesions in the conducting system, it is now apparent that the solu- tion 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. =d 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 correlated with these post- mortem findings. Three hearts from patients with a clinical history suggesting heart- block were kindly entrusted to us for microscopic examination; two by Dr. MacCallum and one by Dr. Bishop. Heart 1. =m-. =m- report has been given by Dr. Bishop. 1 The patient, a watchman, aged 75, was admitted to Lincoln Hospital, Oct. 22, 1908. His family history was negative. He had had measles, whooping-cough and small-pox when a child. Later in life he had had muscular rheumatism and a sunstroke. He had drunk whisky moderately. Syphilitic history was denied. The patient was described as having a slow pulse, vertiginous and syncopal attacks and rapid venous pulse. The radial artery was not thickened, even to the degree that would be expected in a patient of his age. A polygraphic tracing was pub- lished in the original article. Macroscopic Examination of the Heart. =m--mortem examination of the heart was made by Dr. Larkin. 2 "The heart showed a calcareous nodule, situ- ated precisely in the path of the bundle of His. This nodule was evidently the cause of the complete heart-block observed during life. "