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Angina Pectoris Symptoms
Source: Disturbances Of The Heart
The pain of true angina pectoris generally starts in the region of
the heart, radiates up around the left chest, into the shoulders,
and often down the left arm. This is typical. It may not follow this
course, however, but may be referred to the right chest, up into the
neck, down toward the stomach, or toward the liver. The attack may
be coincident with acute abdominal pain, almost simulating a gastric
crisis of locomotor ataxia. There may also be coincident pains down
the legs. It has been shown, as mentioned in another part of this
book, that disturbances in different parts of the aorta may cause
pain and the pain be referred to different regions, depending on the
Instances occasionally occur in which a patient had an anginal
attack, as denoted by facial anxiety, paleness, holding of the
breath, and a slow, weak pulse, without real pain. This has been
called angina sine dolore. The patient has an appearanece of anxious
expectation, as though he feared something terrible was about to
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.
Besides the feeling of constriction, even to some spasm, perhaps, of
the intercostal muscles, respiration is slowed or very shallow,
because of the reflex desire of the patient not to add to the pain
by breathing. The face is pale, the eyes show fear, and the whole
expression is almost typical of cardiac anxiety. The patient feels
that he is about to die. The pulse is generally slowed, may be
irregular, and may not be felt at the wrist. The blood pressure has
been found at times to be increased. It could of course be taken
only in those cases in which there were more or less continued
anginal pains; the true typical acute angina pectoris attack is
over, or the patient is dead, before any blood pressure
determination could be made. When there is more or less constant
ache or frequent slight attacks of pain, the blood pressure may be
raised by the causative disease, arteriosclerosis. During the acute
attack with inefficient cardiac action and a diminished force and
frequency of the beat, the peripheral blood pressure can only be
The duration of an acute attack, that is, the acute pain, is
generally but a few seconds, sometimes a few minutes, and rarely has
lasted for several hours. In the latter cases some obstruction to an
artery has been found at necropsy, but not sufficient to stop the
circulation at a vital point. Repeated slight attacks, more or less
severe, may occur frequently throughout one or more days, or even
perhaps a series of days, caused by the least exertion, even that of
turning in bed.
While most cases of sudden death with cardiac pain are due to a
local disease in or around the heart, it is quite probable that some
disturbance in the medulla oblongata may cause acute inhibitory
stoppage of the heart through the pneumogastric (vagi) nerves. The
power of the pneumogastric reflex to inhibit the action of the heart
is, of course, easily demonstrated pharmacologically. Clinically
reflexes down these nerves interfering with the heart's action cause
faintness and serious prostration, if not actual shock, and perhaps,
at times, death. The most frequent cause of such a reflex is
abdominal pain, perhaps due to some serious condition in the
stomach, to gastralgia, to an intestinal twist, to intussusception
or other obstruction, or to hepatic or renal colic. A severe nerve
injury anywhere may cause such a heart reflex. Hence serious nerve
pain must always be stopped almost immediately, else cardiac and
vasomotor shock will occur. In serious pain morphin becomes a life
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