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Medical ArticlesFelon - Whitlow
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Source: Disturbances Of The Heart
While this name is more or less unfortunate, it has long been in
vogue as a designation for pains and disturbances referred by a
patient to his heart. Therefore with the distinct understanding that
if the diagnosis is correct the name is a misnomer, it may be
allowable to discuss under this heading some of the attacks which
may simulate an angina and must be separated from a true angina.
To decide whether pain in the region of the heart or irregularity of
its action is due to organic disease, to functional disturbance, or
to referred causes is often extremely difficult. Some of the most
disturbing sensations in the region of the heart are not due to any
organic trouble, and yet the patient is fearful that such sensations
mean some kind of heart disease, and therefore becomes exceedingly
anxious and watches and mentally records every sensation in the left
chest. This is unfortunate, as the patient may learn to note, if he
does not actually count, his heart beats, while normally he should
sense nothing of his heart's activity. On the other hand, as just
stated, it may be almost impossible to decide that this disturbance
of the heart is not due to an organic cause, but is entirely
functional, or due to some extraneous reason.
It seems justifiable in every case of irregular heart action to
assure the patient that the condition can be improved, which in most
instances is the truth. There can be no question of such urgent
assurance, if it is decided that the cause is not in the heart
itself, or at least is not organic. Irregularities in the heart's
action will be discussed later. At this time discussion will be
limited to pain which is not true angina pectoris, but which is in
the region of the heart or is referred to it.
Intercostal neuralgia is more likely to occur on the left side of
the chest than on the right. This is particularly unfortunate, as
tending to cause these pains to be referred to the heart. The
localization of tender spots along the course of a nerve with
demonstration of these to the patient and the diagnosis stated is
all the assurance that he requires.
Careful questioning, and if necessary scientific examination of the
stomach, may show that the patient has hyperchlorhydria, ulcer of
the stomach or duodenum, dilatation of the stomach, or some growth
in the stomach as a cause for the pain referred to the region of the
heart. Gallstones in the gallbladder may also give such referred
pains. Other lesions in the abdomen may cause pain referred to the
cardiac region. Not only will the demonstration of these causes and
their treatment assure the patient that he has not neuralgia of his
heart, but also, if curable, the cause of the pain may be removed.
Dry pleurisy of the left chest is not an infrequent cause of these
pains, and of course serious disease of the lungs, as tuberculosis,
unresolved pneumonia, pleuritic adhesions, ennphysema and tumor
growths, may all be the cause of a referred cardiac pain, the heart
being disturbed secondarily.
A stomach cramp is a not infrequent cause of serious pain referred
to the heart, and the rare condition of cardiospasm must also be
remembered as a cause of pseudo-angina. In other words, the
interpretation of these pseudo-anginas means a careful diagnosis of
the condition, and, as previously stated, not only must the above-
named causes be excluded, but also the reverse must be remembered:
that many disturbances treated as other conditions really are due to
cardiac weakness. 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. A false angina shows no such paleness, allows
deep breathing, crying and lamenting, and allows the patient to move
about in bed, or about the room. The true angina makes the patient
absolutely still and quiet: he hardly dares to speak or tell what he
is feeling and fearing. True angina is of course much more frequent
in older persons, while false anginas occur in the young, and
especially in the neurotic. With all the other manifestations of
hysteria, palpitation and cardiac pain are often symptoms.
It should not be decided, however apparently self-evident that a
referred pain is not due to cardiac lesion until a careful
examination of the patient has been made. Real cardiac disturbance
can of course occur at any time in a neurotic or hysterical patient,
and there should be no mistakes of omission from carelessness or
neglect on the part of the physician.
Other frequent causes of more or less disturbance of the heart's
action, often accompanied by pain, are overexertion, worry and
mental anxiety, and intestinal toxemias due to too much protein or
disturbed protein digestion. Frequent causes are tobacco, and the
overuse of tea and coffee. Many a patient's pseudo-anginas are
corrected by stopping tea and coffee. The effects of caffein and
tobacco on the heart will be considered later when toxic
disturbances are under discussion.
The above-mentioned causes of pseudo-anginas have only to be named
to indicate the treatment which will prevent the pain attacks. At
times, the cause being intangible, it may be necessary to change the
whole life and metabolism of the patient, as so often necessary in
hysteria, neurasthenia, gout, intestinal fermentation and kidney
inefficiency. Besides a rearrangement of the diet and measures for
causing proper activity of the bowels, massage, exercise and
hydrotherapy should lie utilized toward the end of improving the
nutrition of every part.
Next: Treatment Of Pseudo-anginas
Previous: Angina Pectoris Management