Sinus bradycardia with cardiac asystole.

A case of sinus bradycardia with cardiac asystole was described in this journal (Pearson, 1945). The subsequent history and the post-mortem findings are now recorded. The patient was a woman aged 52 years who had been under observation since February 1943. Her pulse rate varied between 16 and 30 and her main symptoms were attacks of unconsciousness, resembling Stokes-Adams attacks; these were shown to be due to periods of asystole lasting up to 22 seconds. The shorter periods of asystole were not accompanied by loss of consciousness. At times these attacks occurred with great frequency, and on one occcasion fifteen were recorded in 45 minutes. It was observed that exercise caused a transient increase of pulse rate; atropin 1/25 of a grain intravenously failed to increase the rate to more than 35 a minute. A radiograph of the heart and lungs at this time was entirely normal. She was discharged from hospital in August 1944. In April 1945, the patient was seen in her home. HIer condition had improved slightly and she had only once lost consciousness since January 1945. She had recorded her pulse rate daily since discharge'and this varied between 26 and 33. She had been out for short walks during the previous month. Examination showed no alteration in her condition and her blood pressure was recorded as 218/140. At this time she was taking half a grain of thyroid sicca t.i.d. and half a grain of barium chloride t.i.d. In July she began to complain of pain in the left side of her chest and was confined to bed by her own doctor. On August 8th her husband found her dead in bed. He had seen her half an hour before and at that time her condition gave no cause for anxiety, nor had she complained of feeling ill. It is presumed that she died in a syncopal attack. Permission was obtained for an autopsy examination which showed the following findings. The apex of the left lung was attached by recent adhesions to the chest wall and there was an effusion of moderate size at the left base. A mass could be felt at the root of the left lung spreading-into the mediastinum. This proved to be a neoplasm which arose in the left upper lobe bronchus. There was very little spread into the lung itself, but a mass could be felt bounded above by the arch …