exertion, psychical irritation, and after eating ; pathological
in all febrile diseases (with each degree of temperature the
pulse is increased 8 beats a minute), common in convales-
cence from them ; in all febrile diseases which lead to con-
sumption (phthisis, anaemia, etc.).
Excessive rapidity (over 160) is a sign of great weakness
of the heart (collapse).
Tachycardia is a sign of disturbed compensation in cardiac
diseases and is often proportional to the intensity of the
disturbance. Tachycardia is also one of the principal symp-
toms of neurotic disease of the heart, and when it appears
in attacks, forms a particular disease (paroxysmal tachy-
cardia).
Tachycardia with exophthalmos, goitre, and tremor of the
fingers, frequently associated with general cachexia, forms
the symptom-complex of Basedow's disease.
The rhythm of the pulse. Irregularity of the pulse
(arythmia) is present in many cardiac diseases without
offering points for differential diagnosis. Arythmia of mild
character is not uncommon araong nervous people, after
excitement, excesses, gastric disturbances, in constipation;
sometimes no reason can be assigned for it. Although
arythmia always demands a careful examination of the
heart, the diagnosis of a cardiac disease should not be made
from this symptom alone.
Emhryocardia is the equalization of the systole and diastole
through the absence of the normal pause following the diastole.
The heart-beats sound like the tick-tack of a clock, like the fcetal
heart-sounds. Embiyocardia is often the expression of a very
weak heart.
Characteristic types of irregular pulse are : Pulsus alternans :
two heart-contractions correspond to one pulse-beat, or the second
pulse-beat is but feebly to be felt. Pulsus bigeminus : every thiri
beat of the pulse is omitted. Pulsus trigeminus : every f oui'th pulsar
tion is omitted. No diagnostic conclusions can be reached from
these irregularities.
