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Source: Disturbances Of The Heart
The immediate conditions to meet are the rapid fluttering heart, the
nervous excitation and cardiac anxiety, and perhaps the most
important of all, the vasomotor spasm that is often so pronounced.
Physically we have, then, a heart with leaking or constricted
valves; in either case more blood is entering the chambers of the
heart than can be expelled in one contraction, while the peripheral
resistance due to the spasm of the blood vessels, because of fear,
becomes greater every minute and tends still more to interfere with
the peripheral circulation and the complete emptying of the heart of
its surplus blood. Owing to the well known stimulus to distention of
hollow muscular organs, the heart contracts faster and faster.
Soon, by some disarrangement of the inhibitory apparatus, the
pneumogastric nerves, the heart loses its governor, and the beats
increase to even 150 a minute, with irregular contractions, the
blood being sent through the arteries with irregular force, as
evidenced by the varying volume of the pulse. At this time, with or
without cardiac pain, which upsets the rhythm of the heart, the
patient becomes frightened at the feeling of impending demise, and
the cerebral reflexes begin to add to the cardiac difficulty. The
breathing becomes nervously rapid, besides that which is due to the
rapid heart. The chill of fear is added to the already contracted
peripheral vessels, and the surface of the body becomes cold, the
extremities sometimes intensely so. Next it seems as if the strongly
contracted arterioles begin actually to prevent some of the
peripheral circulation, the blood is piled up in the large arteries,
and the venous circulation becomes more and more sluggish, while the
lips, finger nails and forehead become cyanotic. Respiration becomes
more rapid and deep; the inspiration being as strong as possible
with every auxiliary muscle taking part, thus making the negative
pressure in the chest aid in bringing the blood back through the
veins. Part of the extra respiratory stimulus comes from the
imperfectly aerated blood reaching the respiratory center.
Two factors may normally, without treatment, stop these paroxysms,
and the "bad heart turn" may be cured spontaneously. The first of
these is self-control. If the patient does not lose his head, by an
effort of the will he saves himself from becoming nervous or
frightened and therefore escapes the result of mental excitement;
the increased peripheral blood pressure from fear does not occur,
and in a shorter or longer time the heart quiets down. The physician
recognizes this power, and gives his patient immediate assurance
that he will soon be all right; the patient who knows his physician
immediately feels this assurance and is quickly improved.
The second factor in spontaneous cure of the heart attack is
relaxation. The exhaustion from the respiratory muscular efforts,
together with the drowsy condition caused by the cerebral hyperemia
and from the imperfectly aerated blood, causes finally a dulling of
the mental acuity, and the nervous excitement abates, which, with
the exhaustion, gives a relaxation of peripheral arterioles: the
resistance to the flow of the blood is removed, the surface of the
body becomes warm, the heart quiets down by the equalization of the
circulation, and the paroxysm is over.
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