Arteriosclerosis and Hypertension, with Chapters on Blood Pressure: 3rd Edition.Warfield, Louis M. (Louis Marshall)
Science
Arteriosclerosis and Hypertension, with Chapters on Blood Pressure: 3rd Edition.
Warfield, Louis M. (Louis Marshall)
Arteries -- Diseases; Blood pressure
"When viewed from the right side of the heart, the bundle can not be
seen, because it is covered by the mesial leaflet of the tricuspid
valve, whose line of attachment passes obliquely over the membranous
septum. Then, if the endocardium is removed from the posterior part of
the septum of the auricle up to the membranous septum, the posterior
part of the auriculoventricular bundle will be exposed. If, in addition,
the membranous septum be removed, the bundle may be traced from the
point to which it could be followed when viewed from the left side as it
passes posteriorly over the muscular septum. In the region of the
auriculoventricular junction it loses its compactness, the fibers
divide, and the bundle seems to fork. One branch passes into the
superficial part of the valve musculature which descends from the
auricles, and the other branch passes directly into the musculature of
the auricle.
"Briefly, the auriculoventricular bundle runs posteriorly in the septum
of the ventricles about 10 mm. below the posterior leaflet of the aortic
semilunar valves; with a gentle curve it passes posteriorly just over
the upper edge of the muscular septum and sends its fibers into the
musculature of the right auricle and of the auricular valves. In the
heart of the adult the bundle is 18 mm. long, 2.5 mm. wide, and 1.5 mm.
thick." (Erlanger.)
All normal impulses have their origin in the sino-auricular node at the
junction of the superior vena cava with the right auricle (Fig. 50).
From there the impulse travels in the wall of the auricle in the
interauricular septum to the node of Tawara or A-V node (Fig. 51),
thence through the bundle of His to be distributed to the fibers of the
right and left ventricles. This sequence is orderly and perfectly
regular.
[Illustration: Fig. 50.--Showing alternating periods of sinus rhythm and
auriculoventricular rhythm. (After Eyster and Evans.)]
[Illustration: Fig. 51.--Period of auriculoventricular or "nodal" rhythm
following exercise in sitting posture. (After Eyster and Evans.)]
It has also been shown that the independent auricular and ventricular
rates vary somewhat, that of the auricle being in general faster than
that of the ventricle. A strip of mammalian ventricle placed outside of
the body in proper surroundings will begin to beat automatically at the
rate of about 40 beats a minute. Experimentally various grades of heart
block have been produced in the dog's heart by more or less compression
of the bundle at the A-V ring. The block may be partial, when two to
nine auricular beats occur to every one of the ventricle, up to
absolute complete block when the auricles and ventricles beat
independently of one another.
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