Thumping of the precordium in ventricular standstill

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      The effects of mechanical stimulation of the heart by blows “fair on the breastbone” are demonstrated in eleven patients. This method is recommended as a routine measure to re-establish automaticity or to maintain cardiac activity while mouth-to-mouth breathing is employed and other methods, such as electrical stimulation or the use of certain pressor amines, are made ready. Blows to the precordium should be tried even if ventricular fibrillation is suspected. Not only may ventricular fibrillation be confused with multiple variform ventricular extrasystoles in the electrocardiogram but it may also be followed by standstill.
      The method succeeds in preserving life by evoking ectopic beats which may reawaken cardiac automatism. In the normal heart mechanical stimulation elicits a single response. In the altered, damaged or hypoxic myocardium a blow may produce a multiple response manifested by a tachycardia or even fibrillation.
      Experimentally, a prolonged ectopic tachycardia follows mechanical stimulation under the influence of a variety of substances but particularly in the presence of calcium deprivation. This effect is best explained by the formation of oscillatory after-potentials occurring in the wake of a single depolarization.
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