=Angina pectoris= is characterized by pain in the cardiac region which
usually extends to the inner side of the upper arm and forearm. “This
region corresponds to the peripheral distribution of the lower cervical
nerves (6th and 7th in the arm) and the upper three or four dorsal
nerves (in the upper arm and the chest).”[104] Occasionally similar
areas of the right side are affected, and in a few there is pain in the
lower jaw and back of the ears. “The starting of the pain is usually
across the chest, about the level of the third ribs, or as low as the
fifth ribs,” although the inception may be anywhere in the left chest
or the arm. The duration of the pain is from a few seconds to several
minutes; sometimes it may remain for several hours.
Osteopathic lesions are invariably found in the upper dorsal, including
ribs, or lower cervical region, which are predisposing factors that
tend to exhaust and weaken the cardiac muscle, and disturb the coronary
circulation, so that resistance is lowered. Thus toxic agents and
infections may readily involve the cardiac tissues. Many cases present
more or less arteriosclerosis, which involves the heart and affects
its circulation. Inflammation of the root of the aorta from syphilis
is a frequent cause. Valvular heart disease and chronic nephritis
are other underlying factors. Worry, strenuous living, and continued
physical strain are to be considered. There are a group of cases, that
are comparatively mild and frequently found in women, that are of
toxic origin, due to intestinal stasis as a result of constipation,
adhesions, etc. The ileo-cecal section is commonly involved in these
instances. Focal infections may be an exciting cause.
The =osteopathic lesions= undoubtedly affect the cardiac innervation,
particularly vasomotor and trophic, thus leading to consequent
disturbances of cardiac circulation and resulting irritation to the
ganglia. Sclerosis and spasm of the coronaries, ischemia, cramping,
exhaustion, and degeneration of the heart muscle, and cardiac
neuralgia, are various results that may take place.
The =paroxysm= usually begins suddenly, often during exertion or
intense mental emotion. The pain is agonizing and of a grip-like
character, and there is a feeling of impending death. The intercostal
muscles are constricted and there may be a feeling of suffocation. The
pains radiate up the neck and down the arm, and may be accompanied by
numbness or tingling. There is usually extreme pallor, and the skin
is ashen. Sweating is not uncommon, and dyspnea may be present. The
attacks occur at intervals, varying from a few days to many years.
After the paroxysms there is instant relief.
Other cases may present less severe attacks.
In the =diagnosis= the only condition with which true angina pectoris
is liable to be confounded is pseudo-angina pectoris. =Pseudo-angina=
or hysterical angina occurs chiefly in women or in neurasthenic men.
These cases are often excited by toxemia. The attack usually occurs
at night and is unassociated with organic heart disease. There is a
feeling of cardiac =distention instead of constriction= as in true
angina. There is emotional excitement and the attack lasts one or
two hours, which is usually longer than that of true angina. The
=prognosis= is unfavorable, although many cases live for a number of
years. A few cases have recovered under a thorough course of treatment.
The =treatment= of angina pectoris consists in correcting the
disordered upper dorsal vertebræ, the upper left ribs over the heart,
and the lower cervicals. Invariably lesions are found in this region
and if the treatment is applied to correct these disorders, the attack
can frequently be relieved. By following up the treatment during the
intervals, a number of cases can be practically cured. A common lesion
found is a slight lateral curvature in the upper dorsal region. This
curvature is oftentimes great enough to cause a subdislocation of
several of the ribs, which certainly complicates the derangement, at
least as far as a quick cure is concerned.
=During= the =attack= raise the ribs over the heart at the point of
constriction so as to relieve the impinged nerve fibers. Hot drinks
are of value. The vagi and phrenic nerves may also be at fault in some
cases. The sensory nerves to the heart are from the first, second and
third dorsals.
Ice-bags or heat applied locally will be a helpful measure. In cases
where there is high arterial tension, an inhibitory treatment to
the upper and middle cervical regions will be of special aid, as it
relieves this tension by affecting the vasomotor nerves. This treatment
will at least overcome the =vasomotor form= of angina pectoris. Hot
foot-baths and friction will also be found of value. In many cases
under forty or forty-five syphilis is a cause. In cases past middle
life there is often organic disease of the circulatory organs.
The patient should at all times avoid any excitement and live a very
quiet life. He should take frequent vacations. He should take the best
of care of himself and his food should be nutritious. In pseudo-angina
the treatment is to relieve the irritation to the nerves affected as
well as the underlying affection.