Hysterical palpitation require the use of Ambra, Asafoetida, Camphor, Castoreum, Crocus, Ignatia, Lilium, Sumbul, Scutellaria and Valeriana.
Some of the most important remedies are the following: Nux moschata. Here the most prominent symptoms are quivering, trembling, fluttering and violent palpitation, labored beating of the heart and a fearful embarrassment. It is asserted to be curative in cases arising from fright, fear, grief, stoppage of urine, uterine troubles, menstrual difficulties, especially indicated in delicate nervous women given to fainting or sensitive to the slightest emotion and when the cardiac condition alternates with uterine or vesicle disorder or even gastric trouble.
Digitalis. Great weakness in the chest, shortness of breath, suffocative constricted feeling in the chest, anguish in the region of the heart with or without palpitation, worse from exercise of the body worse from mental emotion, fear if he moves will cause heart to stop beating.
Gelsemium. Is the opposite of Digitalis in that the patient must move or the heart will stop beating and is worse when thinking about his trouble. Hearts action slow and feeble, chills with pain in the head, cold hands and feet.
Aconite. Great anxiety, fear of sudden death, violent palpitation,s full bounding pules, lies on the back with shoulders raised.
Coffea. Due to excessive joy, strong quick pulse with sleeplessness.
Ignatia. Caused by sudden grief, anxious feeling in the precordia, constriction at the heart, disposition to cry and to sigh. ANGINA PECTORIS
Owing to the poorly understood pathology and etiology I have taken this subject up separately. In Heberdens description we have one of the best descriptions of the clinical features which is as follows:
1st. The sudden attacks of depression in the chest, with a feeling of strangling as though the sternum were being drawn to the spine, or in the words of Matthew Arnold “as though there were a mountain upon the chest.”
2nd. The mental anguish with fear of impending death.
3rd. The intense pain situated sometimes in the lower, sometimes in the upper part of the sternum, more frequently to the left then to the right and very often radiating to the arm, especially the left.
4th. Some of the disturbances of sensation such as numbness.
5th. Changes in the pulse in some cases. Intermissions, extra systoles in some cases, alternating pulse in others.
6th. Extreme pallor and constriction of peripheral arteries during the attack.
7th. The sudden flatulence and digestive disorders, bending down in undressing, mental excitement or anxiety and especially anger.
ETIOLOGY
Many theories have been advanced to explain the causation of pain in anginal attacks. These may be classified as follows:
1st. Coronary stenosis.
2nd. Vasoconstrictor spasm of the coronary arteries.
3rd. Acute dilation of the heart.
4th. Neuritis of the cardiac nerves.
5th. Neuralgia of the cardiac nerves.
6th. Action of other constitutional diseases like gout, diabetes, chronic nephritis.
DIAGNOSIS
This is made by the character of the pain and the cause and need not be taken up there. TREATMENT
It is difficult as you have no doubt found to treat a single paroxysm. It is generally of such short duration that no remedy can be selected and given before the attack is over. Assuring the patient that he will not die is of much service for the deadly fear added to the pain. There is some reliable testimony that a dose of Arsenicum 30 has shortened the paroxysm. The same is true of Lachesis 30. If with the general prostration the skin becomes suddenly very cold and clammy and cramps of the extremities set in Veratrum album will do much good.
Arsenic is probably the mostly reliable remedy. Hartman says:
Not only the actual paroxysm but the disease generally finds in Arsenic its appropriate remedy, provided the disorder is not complicated by structural changes in the heart and large arteries….It is indicated if the patient is compelled to breath gently with his chest stooping forward and if the least motion causes a complete loss of breath, if oppression and stitches in the precordial region are associated with anxiety and a fainting sort of weakness; if the breath gives out even while the patient is getting out of bed and if it takes him a long time to recover his breth; or if the paroxysm is started by a simple change of position in bed.
To these indications Hale adds regularly recurring paroxysms as sometimes occur in malarial districts.
Lachesis and Naja are useful when the pain and dyspnoea are concomitants of organic disease of the heart causing distressing sensations of choking, constriction, or rising in the throat and inability to speak. Hale uses the 200th and repeats not oftener than every 12 hours.
Seattle.
Chairman, Bureau of Surgery