Pseudo-angina


Categories: Uncategorized
Sources: 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.





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