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ANGINA PECTORIS: TRUE AND FALSE
Heart Starvation and Heart Exhaustion
More alarm is caused by pain about the heart than by distressed action of any other organ. Much of this alarm is unnecessary and the following explanation of pain in the chest, often wrongly attributed to anging pectoris should do much to remove it. The nature and treatment of true anging are here fully explained.
The ailment itself is characterised by a violent and terrible pain in the chest. This may some on with extreme suddenness so that the victim appears to be gripped in a vice. His face grows deathly pale, perspiration breaks out on his brow, his breathing is" strangled," and frequently he dies on the spot. Happily, that extreme form of heart pain is rare. Much more common is the milder condition, rarely fatal, in which attacks of a less severe form occur on exertion or during excitement.
That, until the year 1914, was the whole story of anging pectoris, though it was usually added that, whereas male victims of the disease commonly died of it sooner or later, women victims were unlikely to die. No explanation of this undoubted fact has ever been furnished.
 
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To-day we know that heart pain is not due to one disease but to many, and that most of the pains felt in the chest are not anging pectoris at all.
The beginning of this new knowledge occurred during the Great War, when it was found that a large number of young soldiers complained of pain over the heart when they exerted themselves. At first doctors suspected anging pectoris. Presently, however, the term "soldier's heart" began to be used.
From this starting point the new study of pains in the chest advanced rapidly. It was found that the same kind of pain might arise from a variety of causes, some of them dangerous, others comparatively harmless. For exam many victims of nervousness suffer from heart pain, so do many rheumatic people so do people with appendicitis, with tonsillitis, and pyorrhoea of the gums. In all these cases the pain, though it may be very severe, is not dangerous to life. There is thus a whole world of difference between true angina pectoris-a comparatively rare disease-and also angina pectoris, which is very common.
It is by no means easy in all cases to make a distinction. Yet there are facts which enable one to arrive at a conclusion in most instanccs. It is necessary to remember that the heart is perhaps the most sensitive and responsive organ in the body. When the nerves connecting the heart with the senses are poisoned and so made irritable, the very smallest events in the outside world become magnified into great and terrible calls for effort. And so the heart which is "controlled" by poisoned nerves is always beating at its fullest strength; that is to say, it is always tired.
Tho owner of that heart will complain of severe pain in the chest-pain which may easily be mistaken for angina pectoris. But the real cause of the pain will not be the heart, but the poison which is acting on the nerves. If that poison can be removed the pain will soon disappear.
The cause may lie in the appendix, or in the teeth, or in the tonsils, or in the bowel. Many cases of false angina pectoris are really cases of chronic constipation. Many others are due to over-eating, over-smoking, or overindulgence. Anything, in fact, which poisons the nerves may give rise to pain in the chest.
There are thousands of these cases. They can all be cured, provided that the real cause is discovered and treated.
What, then, is the difference between exhaustion due to exertion or poisoned nerves and exhaustion due to the heart itself ? The answer is that in real angina pectoris the tiny blood vessels which feed the muscles of the heart have become too narrow. The heart is oxygen starved. In real angina pectoris the heart is starved of its food-especially when it is working harder than usual. The small blood vessels which feed the heart muscles are very elastic in healthy people as the heart beats faster they stretch and widen so as to give it more and still more blood. If however, they have become diseased with what is called arteriosclerosis (q.v.) they lose this elasticity and grow hard. They cannot widen and so cannot supply more blood when more is needed. And so the starved heart becomes exhausted and terrible pain is felt over the chest on oxygen demand.
The heart may stop in these conditions, or may go on with difficulty. In any case the patient will suffer great agony and experience great fear. He must carefully avoid exertion or excitement and must lead a very quiet life. By doing this he may manage, for a time at any rate, to avoid the attacks of pain.
In all cases of pain in the chest it is the condition of the arteries which counts. If these, so far as they can be felt, seem to be soft and healthy, if the patient is a female, or a youngish man, if the attacks are of moderate severity and not always brought on by exertion, and yield to treatment of the underlying condition, the patient is probably suffering from false angina pectoris; if on the contrary, the arteries are hard and inelastic, and if the patient is a man past middle age the attacks definitely induced by exertion or exeitement and aocompanied by a sense of impending death, true angina pectoris is probably present.
Obviously the treatment must be suited to the nature of the complaint. Thus, if a boy who is playing strenuous games complains of pains in his chest, the treatment will be to give him a rest and let him recover his strength. Again, if the pain occurs in people who show other signs of poisoned nerves, the treatment must be directed to getting rid of the poison after it has been found.
The treatment of true angina pectoris is quite different. Here the worn-out blood vessels are full of lime-hard deposits and fragile; it is scarcely possible to cure them. All that can be done is to ease the strain on them so far as possible, and at the same time supply the patient with some means of helping himself when the attack comes on.
The best way of achieve this latter object is to give the drug known as nitroglycerine.
This remarkable substance has the power of causing the vessels of the heart to flush. Flushing, of course, means that the heart has filled full of blood, and this again means that, for the moment, the pressure in the blood vessels has grown less. The blood pressure in the larger arteries, as well as in the smaller, is lowered and the work of the heart is lightened thereby. This brings the desired relief. This drug should only be given under the direction of a physician.
The sufferer from true angina must live within the limits of his heart's strength. The diet in these cases should be frugal. Alcohol should not be taken and smoking must be eliminated. Otherwise, any foods that are fancied and which prove to be within the patient's digestive powers may be given. The clothing should be warm and light, and strains, chills, excitement and worries should be avoided as far as may be possible.
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