Carl Bornemann

Thumping of the precordium in ventricular standstill

Abstract The effects of mechanical stimulation of the heart by blows “fair on the breastbone” are demonstrated in eleven patients. This method is recommended as a routine measure to re-establish automaticity or to maintain cardiac activity while mouth-to-mouth breathing is employed and other methods, such as electrical stimulation or the use of certain pressor amines, are made ready. Blows to the precordium should be tried even if ventricular fibrillation is suspected. Not only may ventricular fibrillation be confused with multiple variform ventricular extrasystoles in the electrocardiogram but it may also be followed by standstill. The method succeeds in preserving life by evoking ectopic beats which may reawaken cardiac automatism. In the normal heart mechanical stimulation elicits a single response. In the altered, damaged or hypoxic myocardium a blow may produce a multiple response manifested by a tachycardia or even fibrillation. Experimentally, a prolonged ectopic tachycardia follows mechanical stimulation under the influence of a variety of substances but particularly in the presence of calcium deprivation. This effect is best explained by the formation of oscillatory after-potentials occurring in the wake of a single depolarization.

A-V Nodal parasystole

Abstract Four instances of parasystole with the ectopic center in the upper portion of the A-V node are described, and several similar observations were collected from the literature. The astonishing fact is stressed that the automaticity of the ectopic center is slow in most of these observations. Unlike ventricular parasystole this form seems to appear in persons with healthy hearts.

Tachycardias with alternation of the ventricular complexes

Abstract Alternating tachycardias with regular or varying cycle lengths may result from stimulus formation in one or two centers. This was established by both experimental and clinical observations. Experimentally rapid impulse formation may evoke an alternating tachycardia from two ventricular centers as in a double parasystole or from a single focus in the A-V node. Clinically alternation could be abolished by carotid sinus pressure with or without slowing; be simulated by interpolated ventricular extrasystoles; be recorded with an increase in A-V nodal rate in patients with bigeminy, and be caused by extrasystoles with different couplings and different forms.

Two cases of the pre-excitation syndrome.

Summary In this report 2 unusual examples of the preexcitation syndrome are described. In the first observation, the form of the ventricular complex changed as the P wave changed. Pre-excitation followed only 1 type of P, left bundle branch block with normal A-V conduction the other type. At other times transitional complexes with short P-R intervals were present. This case is explained best on the basis of a by-pass within the A-V node region. In the second observation, attacks of paroxysmal supraventricular tachycardia in a patient with coarctation of the aorta and pre-excitation repeatedly exhibited a pattern of an acute inferior wall myocardial infarction. This may result from several causes although we favor preexisting infarction masked in the control electrocardiogram.

An arrhythmia, presumably caused by A-V nodal parasystole.

Abstract Tracings obtained from a patient with active rheumatic fever are analyzed. They reveal a rare type of arrhythmia interpreted as being due to A-V nodal parasystole. Other possibilities of interpretation are discussed.

A case of pre-excitation

Abstract A 57-year-old man with paroxysmal tachycardias since 31 years of age and pre-excitation discovered at age 55 was hospitalized at age 57 for a myocardial infarction. Serial electrocardiograms showed Type A pre-excitation as well as normal conduction. The patient was studied six weeks after his infarction with carotid sinus pressure. This induced Type A pre-excitation having QRS complexes of two different configurations without a change in the P-R interval or the delta wave, best explained as resulting from inhibition of conduction over James fibers, and activation over a Kent bundle only.