Transcript Document

Storia (o meglio preistoria) della
fibrillazione atriale
Prof. Luigi Padeletti
Università degli Studi di Firenze
“Quando l’uomo è sereno e sano la
pulsazione scorre continua e costante come
una accanto all’altra sono infilate le perle o
un filo di giada”
Ching (3000 a.C.)
Pen tsao or System of Medicine
1. Chieh pulse
“intermittent,slow,with occasional missing beats”
2. Tsu pulse
“running, rapid, with occasional missing beats”
3. Tai pulse
“irregular, tremulous,beats occur at irregular
intervals”
Li Shi-chen (1500 a.C.)
Polso dicroto (δίκροτοσ =doppio battito)
Herophilus (300 a.C.)
- dicrotus
- intermittens
Pulsus
- intercidens
- deficiens
- caprisans
Galeno 19,410
”Mors porro repentina ex intermittentibus
evenit pulsibus, quo modo ex apoplexia
extinguitur enim in utrisque caliditas quae in
corde est, respiratione privata”
Galeno 9,544
”…nos tamen signum hoc non solum in
pueris, & senibus, ut idem asservit Galenus,
sed etiam in juvenibus, & robustis frequenter
nullo modo funestum observavimus…”
Lancisi (1707)
”En général, de quelque espece que soient
les intermissions, elles ne suffisent pas
seules pour qu’on puisse prononcer sur la
mort ou sur la vie”
de Senac (1749)
Polso dicroto
emorragie nasali
Polso intermittente
crisi diarroiche
Polso inciduus
crisi di sudorazione
Solano de Luque (1731)
”The origin of the pulse is as mysterious as
the source of the Nile”
Abercromby (1685)
”There is just the one cause of arterial
pulsation throughout the body, and that is
contraction of the left ventricle. The
pulsation of the artery-like vein (pulmonary
artery) is similarly related to the contraction
of the right ventricle…”
Harvey W. (1621)
”The facts above stated relative to the
discordance existing between the pulsation
of the heart and of the arteries , more
especially as to strenght, are contrary to the
more
general
opinion
of
modern
physiologists who consider the action of the
arteries as entirely dependent on that of the
hearth.”
Laennec
(1819)
” ... If at this time you cut the apex of the
heart with a pair of scissors you will see
blood flow out from the wound with each
beat of the auricle. You will thus realize that
the blood gets into the ventricle not through
any pull exerted by the distended heart but
through the driving force exerted by the beat
of the auricles.”
Harvey W. (1621)
“But I . .. have noticed, that after the heart
proper, and even the right auricle were
ceasing to beat and appeared on the point
of death, an obscure movement, undulation/
palpitation had clearly continued in the right
auricular blood itself for as long as the blood
was perceptibly imbued with warmth and
spirit.”
Harvey W. (1621)
“The causes of palpitation are not the
causes of the natural heart-beat"
“If the auricles are strained and increased in
volume they cause palpitations…”
de Senac (1783)
“Extremely irregular action of the heart is
almost pathognomonic of mitral stenosis”
Adams R. (1827)
“Ataxia of the pulse”
Bouilland (1835)
“Delirium cordis”
Nothnagel (1855)
“Pulsus
irregularis perpetuus”
Hering (1903)
“It remains now to discuss those cases in which the
hearth presents an apparently or really complete
irregularity of action – cases that are often called by
the name “delirium cordis”. It has long been known
that such a complete iregularity of the hearth has no
definite significance for the condition of the hearth
itself. Many persons , especially those more
advanced in years , enjoy perfect good health , and
are quite able for their work,in spite of a continued
extreme irregularity of the hearth.”
Wenckebach KF(1904)
Mechanically , Mackenzie noted the absence
of the presystolic ‘a’ wave seen in the jugular
phlebogram during “pulsus irregularis
perpetuus”
“ nodal rhythm “
He described his findings as “ the most
puzzling of all forms of irregularity of the
hearth , where the hearth is never regular in
its action , where seldom or never two beats of
the same character follow onw another”
Fibrillation was first noted in response to
strong , continuos (faradic) current application
to the ventricles in 1850. A similar behavior of
the atria was noted by Vulpian in 1874, who
applied the term “frémissement fibrillaire”
“Cushny was the first to suggest auricular
fibrillation might be a factor of clinical
importance, and comparing the radial tracing
from a human subject with the tracing from a
dog in which they produced experimental
fibrillation of the auricles, it was agreed that
auricular fibrillation might be the cause of
irregular heart action”
Mackenzie (1914)
First published electrocardiograph
of atrial fibrillation.
Einthoven W (1906)
“Electrocardiograms taken from patients exhibiting the
irregularity (pulsus irregularis perpetuus)show a number of
irregular waves, apart from the ventricular curve;…They
are found in no other disorder of the heart’s action.They
disappear when in a paroxysmal case, the irregularity
vanishes, and are therefore due to a temporary and
disorderly action of some part of the heart wall…Fibrillation
of the auricle yields curves which are identical in every
respect…Further the waves on the experimental
electrocardiograms can be shown to correspond to the
fibrillary movements in the auricle… The facts point clearly
to the conclusion that the irregularity in question is the
result of auricular fibrillation”
Lewis (1909)
Dear Professor Einthoven,
Sept. 2, 1919
… At present we are working at Fibrillation of the
Auricles, but it is a very tough nut to crack.
With kindest regards, Very sincerely, yours,
Thomas Lewis.