Cardiac Form of American Trypanosomiasis.
Cardiac Form of American Trypanosomiasis.
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DOI：
10.1590/s0074-02761922000100001
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发表时间：
1922-01-01
影响因子：
2.8
通讯作者：
Villela, Enrico
中科院分区：
文献类型：
--
作者：
Chagas, Carlos;Villela, Enrico
在美国锥虫病的临床表现中，有一些非常稳定和突出的症状，这些症状表征了该疾病的心脏形式。根据对大量病例的观察，作者指出，这些病例可分为两组：一类是由肌肉引起的心脏变化，另一类是由神经影响不足引起的心脏变化；然而，后者通常与前者联系在一起。心律失常构成了这类心脏病的主要特征，在其各种类型中被解释为肌肉主要功能的异常。作者研究了以下节奏组和变化：完全性心动过速和心动过缓（窦源性）。2. 传导性改变，表现为- (a)收缩刺激传导延迟（pv空间ac增加）；(b)部分阻塞；(c)完全传导阻滞（室性心律分离，室性心律持续）。3. 早搏- (a)耳廓早搏；(b)室性心动过速；(c)淋巴结性心动过速。4. 耳廓心动过速（耳廓扑动）5. 阵发性心动过速（耳型、室型和结型）。6. 完全性心律失常（耳颤）。7. 心脏病变。每一种情况都有相当详细的论述。在“心脏形式的一般症状学”的标题下，作者考虑了主要特征，或者更确切地说，那些重复频率最高的特征。气血不足的症状占首位，表现为动脉张力低、内脏充血、呼吸困难、用力疲劳、水肿等。与在布莱特氏病中所见的水肿相比，水肿相对轻微，无疑是由于肾脏没有改变。只有在相对罕见的心脏骤停病例中才会出现大面积浸润。高频率的生理标志是心脏容量的增加。其他征象是由瓣膜功能不全引起的杂音，心音模糊，心尖搏动强度和振幅的改变。各种主观症状，特别是那些直接相关的不同形式的心律失常，处理相当详细。有些病人主诉心前焦虑和一种源自上腹部或心前膜并上升至喉咙的收缩感，在那里最强烈并引起呼吸困难和压迫，常伴有昏厥和短暂性头晕。其他患者是指全身不适，感觉心跳或快或慢，上腹部和喉部疼痛，伴有呼吸困难。最后，许多病人只是抱怨“痛苦”，而不能定义或定位构成痛苦的感觉。作者补充说，“痛苦”对症状学的学生来说毫无意义，但对病人来说却是一切。心悸是这种疾病的另一种常见症状；它们几乎总是在短暂的危机中发生，并使患者感受到最痛苦的感觉。昏厥是一种非常常见的症状，有时仅限于简单的短暂性视力模糊，但在其他时候更强烈，并伴有眩晕和意识丧失。关于预后，作者指出，心脏形式是导致死亡率最高的疾病类型。病情是进行性的；没有倒退的可能性，疾病或多或少会迅速发展到致命的结局。本文给出了作者注意到的63例病例的临床细节。在一个简短的摘要中是不可能充分处理这篇冗长的论文的。有兴趣的人可以参考原文。[au:]
In the clinical picture of American trypanosomiasis there are certain very constant and prominent symptoms which characterize the cardiac form of the disease. As the result of observing a large number of cases, the authors state that they can be divided into two groups: one in which the cardiac changes are of muscular origin and the other in which the changes are associated with deficient nervous influences; the latter are, however, usually associated with the former. Arrhythmia constitutes the predominant note in such cardiopathies, and in its various types are interpreted anomalies of the principal functions of the muscle. The authors have studied the following groups and alterations of rhythm: -1. Total tachycardias and bradycardias (of sinus origin). 2. Alterations of conductibility, manifested by- (a) delay in the conduction of the contractile stimulus (increase of the space ac of P.V.); (b) partial block; (c) total block (dissociation of auriculoventricular rhythm with persistence of ventricular rhythm). 3. Premature contractions- (a) auricular extrasystoles; (b) ventricular extrasystoles; (c) nodal extrasystoles. 4. Auricular tachysystole (auricular flutter). 5. Paroxystic tachycardia (auricular, ventricular and nodal). 6. Complete arrhythmia (auricular fibrillation). 7. Cardiac alterations. Each of these conditions is dealt with in considerable detail. Under the heading " General symptomatology of the cardiac form, " the authors consider the principal features, or rather those which are repeated with the greatest frequency. The symptoms of insufficiency occupy the first place and are indicated by low arterial tension, visceral congestion, dyspnoea, fatigue on exertion, oedemas, etc. The oedemas are relatively slight as compared with those seen in Bright's disease, doubtless on account of the absence of renal changes. The great generalized infiltration is only observed in relatively rare cases of cardiac asystole. The physical sign of great frequency is increase in the volume of the heart. Other signs are murmurs due to valvular insufficiency, obscuring of the heart sounds, alterations in intensity, and amplitude of the apex beat. The various subjective symptoms, especially those directly related to the different forms of arrhythmia, are dealt with in considerable detail. Some patients complain of precordial anxiety and a sense of constriction originating in the epigastrium or the precordium and ascending to the throat, where it is most intense and causes dyspnoea and oppression, frequently followed by faintness and transitory dizziness. Other patients refer to general malaise with unpleasant perception of the heart beats, rapid or slow, and painful sensations in the epigastrium and larynx, accompanied by respiratory difficulty. Finally, a large number of patients complain only of the " agony, " without being able to define or localize the sensations that constitute it. The authors add that " agony " means nothing to the student of symptomatology, but everything to the patient. Palpitations form another symptom of great frequence in the cardiac form of the disease; they occur almost always in crises of short duration and subject the patient to the most painful sensations. Faintness is a very common symptom, and is sometimes limited to simple transitory obscurity of vision, but at other times is more intense and accompanied by vertigo and loss of consciousness. Referring to the prognosis, the authors state that the cardiac form is the type of the disease which occasions the greatest mortality. The condition is progressive; there is no possibility of retrogression, and the disease proceeds more or less rapidly to a fatal termination. Clinical details are given of 63 cases which came under the notice of the authors. [It is impossible in a short summary to deal adequately with this lengthy paper. Those interested should consult it in the original.] W. Y.