=Palpitation= is a more or less rapid action of the heart, of which
the patient is conscious. There is usually an irregular or forcible
action of the heart, as well as a frequency of the heart-beat. There
is generally some local irritation to the cardiac nerves; especially
are =lesions= found to the third and fourth ribs, although a lesion
may be higher or lower in the dorsals or it may be in the cervical
area. Muscular lesions are frequent. These lesions predispose to
the disturbances of reflex stimuli, still the general health may be
so weakened or the reflex irritation so pronounced that palpitation
results independently of predisposing osteopathic lesions. Females are
more liable to be affected. The neurotic state is a common source of
the disorder. If palpitation is long continued it causes hypertrophy.
It often occurs at puberty, during menstruation and at the climacteric
period. Anemia, the acute infectious diseases, dyspepsia, disturbances
of the ovaries and other pelvic organs are common causes. The abuse
of coffee, tea, alcohol, tobacco; diseases of the stomach, overwork,
fright, grief, anxiety, and sexual excesses are causative factors.
Palpitation may be associated with organic diseases of the heart, but
as a rule it is a purely nervous affection.
The patient’s perception of the increased action and force of the heart
is the =essential element= in palpitation. The action of the heart
varies greatly and at times it may be a mere fluttering which lasts but
a few minutes. In severe cases the heart beats violently and the pulse
may be rapidly increased and reach 160 or more. The face is usually
pale, but may be flushed. The heart’s action is not increased in some
cases. The attack generally lasts only a few minutes.
The first consideration in =treatment= is to locate the disturbing
factor. Raising the ribs over the heart and lowering the first rib;
correcting the clavicle in a few instances, or inhibiting along the
upper dorsal region will usually quiet the heart’s action. Stimulation
of the vagi nerves, as they pass along the side of the neck, may be all
that is necessary; in some cases inhibition of the superior cervical
sympathetic or of the middle cervical region, acting on the depressor
nerve of the heart, will lessen the tumultuous action of the heart. It
will be recalled that either there is irritation of the accelerator
nerves of the heart or the vagus is inhibited.
All =reflex disturbances=, as a displaced uterus, indigestion, etc.,
must be removed before the palpitation can be permanently stopped.
Rest and confidence in the treatment are of great importance. A very
few cases will require a hot bath and a general treatment and possibly
an ice-bag over the heart to quiet the increased activity. In =anemic
cases= hygienic measures and a proper diet, coupled with the treatment
for anemia, are indicated. If the attack is severe, the patient should
rest in a recumbent posture and drink something warm, besides receiving
the indicated treatment. When the patient is not a decided neurasthenic
a rapid five or ten minute walk will often normalize the heart’s action.
=Tachycardia= is rapid action of the heart and commonly occurs in
paroxysms. There are no heart sensations, as in palpitation. Either
the sympathetics are stimulated or the vagus inhibited. It is not
generally related to lesions of the heart, but is in reality a
=disorder= of the =nervous system=. In some instances the condition
is physiologic. Nervous strain, in the form of =osteopathic lesions=
to the upper dorsal or cervicals irritating the sympathetic, is the
most common cause. Emotion, fright and severe exercise are other
causes. It is found in neurasthenia, anemia, hysteria and in those
using an excessive amount of tobacco, tea and coffee. =Reflex stimuli=
from abdominal or pelvic disorder, especially during the climacteric
may induce tachycardia. In exophthalmic goitre the sympathetics are
overstimulated, and in some instances the vagus inhibited, leading to
“heart hurry.” Tumors, hemorrhages, enlarged glands, etc., obstructing
the action of the vagus, are a source of rapid heart.
Sudden onset with rapid action of the heart, small weak pulse,
headache, flushed face and faintness are common =symptoms=.
The =treatment= is somewhat similar to that outlined under palpitation.
Locating the cause is the first essential. Besides removing local
osteopathic lesions, inhibition to the cervical and dorsal sympathetics
is effective. Raising the ribs over the heart will lessen the
pulse-rate.
Rest, diet and general care of the patient may be necessary. Outdoor
exercise and cold bathing are beneficial. In a few cases springing the
dorsal spine forward, raising the floating ribs, and slight traction of
the cervical spine are effective in slowing the heart’s activity. A few
cases are very refractory, especially in neurotics.
=Brachycardia=, or slow action of the heart, is the opposite of
tachycardia. In a few cases it is physiologic. It usually occurs
secondarily, following infectious diseases; accompanying nervous
disorders, as hysteria, melancholia and neurasthenia, and is associated
with diseases of the digestive organs, pulmonary disorders and toxic
effects of coffee, tea, tobacco, and drugs and the toxins of jaundice,
diabetes, uremia, etc. Obstructions to the cervical sympathetics and
irritations of the vagus, from osteopathic lesions, may be either
direct causes in themselves or predisposing factors in the above
diseases.
A =slow, weak pulse= is the characteristic symptom. The heart sounds
are feeble. When the pulse beat is below sixty per minute it is
diagnostic.
In the =treatment= of slow heart, as in the other neuroses of the
heart, the cause should be first determined. A stimulating treatment
to the cervical sympathetics and inhibition to the pneumogastric
will readily relieve many cases, at least temporarily. The lesion
may be directly to these nerves and of course removal of the same
is essential. Inhibition of the pneumogastric probably affects the
activity of the depressor nerve, and stimulation of the cervical
sympathetics, besides acting on the accelerator fibers of the heart
directly, influences the blood supply of the body and thus increases
arterial tension. Stimulation to the upper chest anteriorly and
posteriorly, over the cardiac region, will increase the rapidity of the
slow heart. Rest and care of the general health is necessary.
=Arhythmia=, or an irregularity of the heart’s action and pulse beat,
often due to lesions in the cervical region interfering with the
vagi, symis pathetic or vasomotor nerves to the heart. In a number
of cases the first, second or third rib on the left side is at fault
and a correction of it will relieve the irregularity immediately.
It is claimed that there are nerves at the fourth and fifth dorsals
that tend to control the rhythm of the heart-beat. Other causes are
organic diseases of the heart and nervous system, reflex disturbances,
excessive use of tobacco, coffee and tea.
“Normally, the contraction of the heart originates at the sinoauricular
node, at the mouth of the superior vena cava, is conducted to the
auricle, and thence to the ventricle by way of the auriculo-ventricular
bundle (bundle of His or Gaskell’s ridge). Under conditions of abnormal
stimulation, contractions may originate in the auriculo-ventricular
node in the wall of the right ventricle near the coronary sinus; or in
the auriculo-ventricular bundle on the ventricular side of the node; or
in the auricular tissue itself.”—Clinical Osteopathy.
Fibers from the right vagus pass to the sinoauricular node, and from
the vagus to the auriculo-ventricular bundle. Lesions of the upper
three cervicals may readily disturb the vagi through circulatory and
chemical sources as well as through the communicating branch of the
second spinal nerve. Thus the rhythmic power of the heart, rate and
strength, and conductivity of impulse may be readily influenced, which
is borne out by clinical experience.
There are several forms of irregular heart action. For a description of
same it is probably best to refer the student to special works.[103]
The more common forms are =Sinus= Irregularities, the =Extrasystole=,
=Paroxysmal Tachycardia=, =Auricular Fibrillation=, =Auricular
Flutter=, and =Heart-block=. =Pulsus Alternans= is a rare form, and is
of grave significance when the heart muscle is degenerated. A knowledge
of =auricular fibrillation= is of special value, for it is a common
form and often indicates a serious condition.
Most of the irregularities are not of special pathological importance,
providing the heart muscle is healthy. They are best studied through
instrumental means and require considerable experience in order to
determine the exact condition.
Frequently, unnecessary worry has been the result in discovering
irregularities in the young as well as in otherwise healthy adults.
Only when the cardiac muscle is diseased or degenerated through various
infections and toxic properties in the blood should they receive
unusual attention.
Dorsal and lower cervical lesions that affect the heart by way of the
sympathetics no doubt disturb nutrition of the heart tissues. And
lesions of the vagi, particularly of the upper three cervicals, will
disturb the rhythm, rate, strength, and conductivity of the impulse
through auricles and ventricles. In no other organ of the body will the
osteopath be better rewarded for careful and painstaking work than in
normalizing the stimuli from sympathetic and vagi that influence the
heart. Stimulatory and inhibitory efforts will frequently suffice, but
in our judgment it is always better to secure interosseous adjustment
if possible.
Though a number of individuals with heart irregularities are of a
neurotic type, that predisposes to nervous disturbances of various
kinds, still it would be an interesting study, especially in cases of
children, to note what percentage are the result of upper cervical
lesions caused by birth injury.