Medicines useful for “irritable heart.”
When from Influenza: Iberis.
From excessive tea or coffee drinking: Agaricine.
From excessive smoking: Ars., Kalm., Phos., Spigelia.
From effects of scarlet fever: Lachesis.
“AORTIC AXIS.” A line drawn from the right sternoclavicular articulation to the normally placed, apex beat, is the “aortic axis.” Along this line aortic murmurs are propagated. In the third left space, near the sternum is the best spot to listen for an aortic regurgitant murmur. At this point the left ventricle is not covered by the pulmonary artery: a little further out also is the tip of the left auricle.
ANGINA PECTORIS. This is usually divided into true and false. This division ought to be abolished, for the so-called “false” is frequently fatal.
The “false” is supposed to be distinguished by the facts that the attack supervenes spontaneously, that the pain lasts longer than in the “true,” that it is accompanied by restless movements, and that it tends to recur again and again, before finally subsiding, and there usually co-exists throbbing of the abdominal aorta, mobility of our kidneys, vaso-motor manifestations and other evidences of nerve instability. The false is said to be most often found in young women: the pain radiates centripetally, and is not specially caused by movement.
In true Angina. the pain is retro-sternal and may spread to arms, chest and neck: the pain is constrictive and is accompanied with a feeling of dread and fear of impending death. Patient will not move is “frozen.” The true form is often due to syphilis, via aortic disease. As a rule it appears first after some definite exertion. Patient should be very careful of chills from cold winds, sudden exertion, excitement, and especially overloading the stomach. The diet should be purine free, and chlorine free. In some cases the first attack may be the last.
LANCINATING PAINS ABOUT HEART. If from base to apex, at night, try Syphilinum; if from apex to base Medorrhinum. From base to clavicle or shoulder, Spigelia.
CONSTRICTING PAINS about heart region, consult Cactus, Spigelia, Carbolic acid and Sulphur.
An Old School observation. When cutaneous hyperaesthesia is marked about the precordia, especially about the apex beat, in over distension or heart failure, and where the least touch causes acute distress, paint apex-region with mother tincture of aconite. The same cutaneous hyperaesthesia is found in acute pericarditis, due to irritation of the intercostal nerves.
If palpitation is marked on first getting into bed, this is often due to nicotine poisoning from excessive smoking. If an attack comes on when lying quietly in bed, suspect Graves disease.
ADHERENT PERICARDIUM. The diaphragm seems fixed and the chest wall is sucked in during respiration, because the ribs dont move. There is an abnormal increase in size of the heart, as the amount of work it has to do is immensely increased, and there are greater signs of cardiac failure than one would expect from the amount of valvular lesion present. In acute pericarditis, there is complete absence of abdominal respiration, and one may mistake it for an abdominal inflammation.
In tubercular disease the heart is usually small: this disease is rare in cases of cardiac disease, especially in mitral stenosis, or in lateral curvature of the spine, or rickety deformities of the chest, or emphysema. Is this from increased venosity of the blood? But in mitral stenosis there is an increase of red blood corpuscles.
The heart rate is increased by inspiration, and decreased by expiration, especially in the young. This is quite normal and is not a sign of disease. Stop respiration and the irregularity disappears. The rate is slow, as compared with the temperature, in typhoid fever, and in influenza.
In “heart troubles” without special symptoms give Naja. For consciousness of a heart give pyrogen: the heart feels “tired.”.
HEART BLOCK. If complete the ventricle beats at its own intrinsic rate of about 30 per minute.
Drugs that have produced complete or partial heart block are Digitalis, Aconitine, Physostigmine, Adrenalin, Muscarin, Yohimbin, Squill and Strophanthus. Digitalis will also produce auricular fibrillation.
Heart block with occasional faints, or epileptic-like seizures, is known as the Stokes-Adams syndrome.
In failing heart, look at feet, lungs and liver. Gallop-rhythm means threatening break-down of the myocardium.
