Abstract

For two centuries after Harvey the arterial pulse was often regarded as independent of the heart beat. This misunderstanding was mainly because of the frequent failure of the irregular heart to elicit a radial pulse: the "pulse deficit" of later times. Harvey observed ineffective palpitation of the atrium just before death. This was probably atrial fibrillation. He established the origin of the heart beat in the right atrium. Harvey's observations were confirmed and extended by de Senac in the mid-eighteenth century. He correlated gross irregularities (palpitation) with necropsy observation of mitral valve disease and dilatation of the left ventricle. He emphasised the origin of the heart's irregularity from the distended atrium consequent on distension or reflux of blood irritating the atrial wall. He also commented on disconcerted action and rippling of the ventricular wall before final cessation of movement in a dying heart (ventricular fibrillation). De Senac's ideas were a century and a half ahead of his time.