Complex arrhythmia probably of traumatic origin.

A married man, aged 49, assistant manager of a factory, was admitted to hospital on May 30, 1945, complaining of exhaustion, palpitation, dyspnea on slight exertion, giddiness and faint turns. He states that his symptoms have been present since January 2, I945, when he was crushed between two lorries, the one being stationary, the other running back. The right anterior costal edge is said to have taken the full impact of the crushing force. Directly upon the accident he was taken to the Surgical Ward (St. John and St. Elizabeth's Hospital), and remained there for a fortnight. His recollection of events during his stay in that hospital is rather hazy, he remembers, however, that he had had no solid food for the first four days. He had abdominal pain under the right costal edge for about four weeks, and became aware of a fluttery feeling in the neck about three weeks after the accident. No attention was paid to his cardiovascular system till his family doctor noticed irregularity of the heart beat on routine examination a month after the accident, February 2, I945. He had had no serious illness previously, and his medical attendant during the last five years describes him as a normal, active man who, apart from mild respiratory infections, never presented any serious symptom. Patient himself emphasized that prior to the accident he led a very active life and was a keen walker. Examination. He is a tall, strongly built, well-covered man. No chest deformity is found. The cardiac impulse is imperceptible; the sounds are distant. The heart action is completely irregular, and there is a considerable pulse deficit on minute count. A short, insignificant systolic murmur in apical area. B.P.: 15o/go. No sign of congestion. Brachial arteries moderately thickened, straight. Over the left pulmonary base scanty fine crepitation. Ophthalmoscopy reveals normal fundi. No abnormalities are found in his nervous system. On external examination of the abdomen nil abnormal detected. On radioscopy, normal-shaped, rather vertical heart silhouette. Irregular pulsations of low amplitude. Low diaphragm. Vascular pedicle of normal appearance. Cardiothoracic ratio, 53 per cent. Circulation time, arm to tongue (calcium gluconate): I8 seconds.