Angina pectoris

“ The resemblance between the symptoms of angina pectoris and the effects of the poison of Latrodectus mactans are so striking as to justify the presentation of a comparison; and it is hoped that physicians of wide reading will pardon what may seem to them a piece of supererogation for the sake of many a humbler practitioner whose opportunities have not been so happy. At the same time, the widest reader must admit that he has not found any one authority who has given a complete picture of angina pectoris. ”

“ The diagnosis of a real angina pectoris from a false angina may not be difficult. A real angina generally occurs after exertion of some kind, be that exertion ever so slight. False angina may occur at any minute with or without exertion. Pain referred to the heart which awakens a patient at night is not likely to be a true angina; nervous patients are prone to have such night attacks of cardiac disturbance of various kinds. A true angina causes the patient's face to look anxious and pale, with the breathing repressed. ”

“ Serious angina pectoris occurs in elderly people whose arteries are degenerate. Its main symptom is a feeling of discomfort which develops in the praecordia,—the region over the heart. {142} This discomfort may often increase to positive cutting pain. The pain is often referred to the shoulder, and runs down the left arm. This set of symptoms is accompanied by an intense sense of impending death. When the patient's arteries are degenerated, this train of symptoms must always be considered of ominous significance. ”

“ I have observed the arms stiffened out, and the hands closely and firmly clinched until death. I have also observed a sense of suffocation in the patient. In some forms of convulsions I have seen contortions both of the legs and the feet, and the patient generally expresses a wish to sit up. I have known persons die of a disease called angina pectoris. The symptoms of that disease, I consider, resemble closely those of Mr. Cook. Angina pectoris comes under the denomination of spasmodic diseases. In some cases the disease is detectable upon post-mortem examination; in others it is not. ”

“ ANGINA PECTORIS This is a name applied to pain in the region of the heart caused by a disturbance in the heart itself. Heart pains and heart aches from various kinds of insufficiency of the heart, or heart weakness, are not exactly what is understood by angina pectoris. It is largely an occurrence in patients beyond the age of 30, and most frequently occurs after 50, although attacks between the ages of 40 and 50 are becoming more frequent. It is a disturbance of the heart which most frequently attacks men, probably more than three fourths of all cases of this disease occurring in men ”

“ The position of the patient with true angina pectoris is characteristic. He stops still wherever he is, stands perfectly erect or bends his body backward, raises his chin, supports himself with one hand, leans against anything that is near him, and places his other hand over his heart, although he exercises very little pressure with this hand. The position assumed is that which will give the left chest the greatest unhampered expansion, as though he would relieve all pressure on the heart. ”

“ The lawyer moistened his dry lips. “But when a man has angina pectoris he knows the end may come at any moment and in any place. Turnbull made no secret of suffering from that disease.” Rochester turned toward Clymer. ”

“ In angina pectoris this drug has a beneficial action; it relieves the pain and distress in many cases, even when amyl nitrite and nitroglycerin have failed entirely. In pseudo-angina, frequently observed in hysterical women, its action is all that can be desired.
Patients who suffer from irritable, weak, or palpitating heart, needing at times a pain reliever, can take Antikamnia tablets, without untoward after-effects, knowing that the heart is being fortified. In delirium tremens, they relieve when there are great restlessness, insomnia, the general lowering of the nerve power. ”

“ Even when we have listened to an account from a middle-aged man of an attack of angina pectoris, what can we tell him of his prospect of life until we have learned whether he be guilty of excessive smoking or drinking, whether he be gouty, whether he have lately strained his heart or no? What I do regard as really valuable prognostically, in the way of a simple clinical observation, is the determination of progressive symptoms and signs. A man of 72 complains of oppression over the lower sternal region as often as he climbs a hill. ”

“ True angina pectoris probably does not occur without some serious organic disease of the heart, mostly coronary sclerosis, fatty degeneration of the heart muscle, adherent pericarditis and perhaps some nerve degenerations. ”

“ While in almost every case of angina pectoris there is disease of the coronary arteries, the contrary does not hold true, for most extensive disease, even embolism, of the arteries is frequently found in persons who never suffered any attacks of pain. This symptom group is more common in males than in females and as a rule occurs only in adult life. "In men under thirty-five syphilitic aortitis is an important factor." ”

“ Charcot, the distinguished neurologist, suffered from attacks of angina pectoris, and was asked by his family to consult a distinguished heart specialist for them. He said: "Either I have degenerated heart arteries, or I have not. I believe that I have not, and that my attacks are due to a nervous condition of my heart. If I should consult the physician you mention, and he were to tell me that my attacks are due to degeneration of the heart, he would advise my giving up work. ”

“ While there are serious affections in which heart and stomach are closely associated, these are quite rare and usually manifest themselves in acute conditions and in old people. In the chapter on Angina Pectoris attention is called to the fact that there are may forms of pseudo-angina due to cardiac neuroses consequent upon gastric disturbance and without heart lesion. ”

“ The action of the heart is more or less disturbed. The beats are irregular, at times being strong, while again they are feeble. A feeling of numbness is experienced in those parts to which the pain penetrates. These paroxysms usually continue but a few minutes, although they sometimes last several hours. Persons suffering from angina pectoris are liable to sudden death. It is connected with ossification, or other organic changes of the heart. Usually these paroxysms, if the life of the patient continues, become more and more frequent. ”

“ I had the opportunity to follow the case of a young woman who had a series of attacks of angina pectoris some twenty years ago, so severe that a bad prognosis seemed surely justified, and though at times the attacks were rather alarming to herself and friends, nothing serious developed and for the past ten years, since she has gained considerably in weight, they have not bothered her at all. She used to be rather thin and delicate, trying to do a large amount of work and living largely on her nervous energy. ”

“ Angina pectoris proper, the severe and often fatal disease met with chiefly in elderly men, is sometimes known in Germany as Herzkrampf, but the established and distinctive German name for the affection is Stenokardia. ”

“ It has been thought by some that the pain in angina pectoris might be due to this cause.
Several curious and interesting diseases which have been thought by some to have arteriosclerosis as a basis are accompanied by pain. Such are erythromelalgia, Raynaud's disease, "dead fingers," and intermittent claudication.
Erb has reported a large series of intermittent limp (claudication) from his private practice. He finds that the large majority of the cases occur in men. ”

“ However earnestly we may attempt to estimate the prognosis on a strictly rational system—that is, by basing it on an accurate and complete diagnosis—we cannot deny that when the individual patient is before us we are influenced directly by certain of the symptoms and signs, without asking ourselves what their respective pathological meaning may be. True bradycardia, the story of an unmistakable attack of angina pectoris, a loud aortic diastolic murmur, the bruit de galop—these instantly give us great concern before we have had time to translate them into the language of morbid anatomy. ”

“ Occasionally the first seizure proves fatal; but more commonly death takes place as the result of repeated attacks. Angina pectoris is extremely rare under middle life, and is much more common in males than in females. It must always be regarded as a disorder of a very serious nature. ”

“ It is at any rate certain that cardiac neuralgia is always a most grave complaint, from the almost total uncertainty whether succeeding attacks will not involve a fatal amount of spasm. As for the expression angina pectoris, it is just one of those mischievous terms which, arising out of the mystified ignorance in which the elder physicians found themselves as to the pathology of internal diseases, have since been attached in turn to various definite organic changes, with none of which they had any essential connection ”

“ MANAGEMENT While a number of causes of true cardiac pain may be eliminated by improvement in any loss of compensation, by improvement of the heart tone, by more or less recovery from myocardial or endocardial inflammation, and by the withdrawal of nicotin, which may cause cardiac pains, still, true angina pectoris once occurring is likely to be caused by a progressive, incurable condition, and the attacks will become more frequent until the final one. ”

“ Four patients I have now in my recollection, all of whom I believed to labour under the angina pectoris in a great degree; which have all recovered, and have continued well three or four years by the use, as I believe, of issues on the inside of each thigh ”

“ He had for years laboured under that form of disease of the heart called angina pectoris (Dr. Arnold's disease) , and for more than twenty years lived as it were on the edge of instant death; but during his later years his health had improved, though he had always to "walk softly," like one whose next step might be into eternity. This bodily sense of peril gave to his noble and leonine face a look of suffering and of seriousness, and of what, in his case, we may truly call godly fear, which all must remember. ”

“ He looked so strong, and full of color and vitality. One could not believe that his words held a prophecy. Yet the pains recurred with increasing frequency and severity; his malady, angina pectoris, was making progress. And how bravely he bore it all! He never complained, never bewailed. I have seen the fierce attack crumple him when we were at billiards, but he would insist on playing in his turn, bowed, his face white, his hand digging at his breast. ”

“ It is compromise, which may be effectual for a long time, but which, like most compromises, comes to failure in the end. Occasionally we find the sclerosis attacking the heart muscle itself or its arteries; such cases are obviously more serious. This condition generally comes on more or less at the end of the disease, but in a few cases quite early. Probably many of the cases of true angina pectoris occurring in early middle life are of this nature, the coronaries being the chief point of attack. ”

“ In true angina pectoris of the horse, treatment is useless. Absolute rest is a prime requisite, and anodynes, stimulants, heart tonics, and nerve tonics are indicated. But the horse at rest with no prospect of final recovery is simply a source of expense.
312 FUNCTIONAL IRREGULARITY IN THE RYTHM OF THE HEART. Associated or not with palpitation, irregularity in the force or frequency of the heart beats is sometimes met with at intervals or independently of any further indication of structural disease. ”

“ In such attacks there are strong radiating pains in the heart region, and a feeling of great anxiety, of utter annihilation, and of instantaneous death; and indeed not so seldom such attacks may terminate in death. These attacks may be considered as a warning of nature that such persons stand on the verge of a precipice and thus urging them to the greatest precautions to avoid anything that may bring about such an attack. From my own observations, rapidly fatal attacks of angina pectoris in such cases of arteriosclerosis happen frequently after a heavy dinner. ”

“ In diseases of the heart the sudden vasodilation caused by amyl nitrite inhalations is indicated only in angina pectoris. "Then the surface of the body tends to be cold, however, when the peripheral blood pressure is increased and the heart is laboring, nitroglycerin in small doses is valuable. The dose may be from 1/400 to 1/100 grain, dissolved on the tongue or given hypodermically for quick action, or given by the mouth for more prolonged action. In sudden cardiac dyspnea nitroglycerin sometimes acts specifically, especially when there is asthma. ”

“ In such cases the signs of degeneration of the heart are very striking: weakening of the cardiac impulse, notable faintness of the sounds of the heart, occasionally reduplication of the second sound, a galloping rhythm, while percussion shows the existence of considerable dilatation of the left, and still more frequently of the right ventricle; in many cases also we have angina pectoris, passive hyperæmia of the lungs, the mucous membranes, and the extremities; and sudden death sometimes ensues. ”