Paroxysmal Tachycardia

Abstract

Two cases of paroxysmal tachycardia demonstrated certain unusual features which appeared to warrant their being reported: Case 1.\p=m-\History.\p=m-\J.E., a girl aged 13, was admitted to the Hospital for Sick Children Aug. 25, 1938. She was the third child in a family of 6. The rest were in good health except for one who had mild kidney trouble and one who occasionally had bronchitis. The patient had usually been in good health. She had measles at the age of 4 years. At 7 she began to have tachycardia at intervals, the attacks lasting from a few minutes to four days. They were usually characterized by the sudden onset of a choking feeling which lasted a few minutes and was followed by a sense of weakness. At such times her heart rate was reported to be close to 200 beats per minute. Often her pulse was difficult to count because of the extremely fast rate. The onset of attacks was occasionally, but not usually, preceded by some excitement. One attack was initiated by her falling down stairs. Three came on while she was eating meals. One occurred during physical activity. None appeared to be initiated by infections. The intervals between paroxysms varied from a few days to several months. After each attack she felt weak and exhausted for two or three days, and often she had a mild headache.There was no history of rheumatic fever or of chorea or of symptoms suggestive of these. Infections of the upper part of the respiratory tract were rare. Her appetite was excellent, and bowel movements were regular. Her menses began when she was 12 years old and had been regular since then, with a normal flow. She was menstruating at the time of admission to the hospital and said that she was more liable to attacks during menstrual periods. The present attack began while she was eating supper. She had a sudden choking sensation and then felt as if her heart had stopped beating. She had been well during the day and had had no premonition of the attack.Physical Examination.--On admission to the Hospital for Sick Children, the child's temperature was 99 F., her pulse rate 200 and her respiratory rate 22. She was well developed, somewhat obese, very apprehensive and almost afraid to move. The pupils reacted to light, and slight strabismus was present. The ears were normal. The teeth were in excellent condition. The tonsils were not enlarged but were cryptic. The breasts were of the enlarged adolescent type. The lungs were resonant throughout, and no adventitious sounds were heard. Breathing was shallow. The heart beats were regular, with a rate of 200 to 210. The heart From the