A system of clinical medicine, dealing with the diagnosis, prognosis, and treatment of disease / 2nd edition.

  • Savill, Thomas Dixon, 1856-1910.
Date:
1909
Catalogue details

Licence: In copyright

Credit: A system of clinical medicine, dealing with the diagnosis, prognosis, and treatment of disease / 2nd edition. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

    68/1012 (page 36)
    1. Most Structural Diseases of the Heart, especially such as are attended by rapidity and irregularity of its rhythm, are attended by palpitation. When patients consult us for this symptom, we should therefore first make a thorough examination of the heart and peri- cardium. 2. Palpitation is also the leading indication of the Irritable Heart, in which there may be no discoverable structural disease. Irritable heart is found in young men who have overtaxed their strength in athletics or military work, and occasionally in young women. Palpita- tion is its most obvious symptom, with a very quick pulse, or one which easily becomes rapid, and sometimes with high arterial tension. Breath- lessness, sleeplessness, incapacity for prolonged exertion, and nervous- ness, often accompany the palpitation. Hypertrophy is a common result; and unless rest be ordered the heart will become dilated. Com- plete rest is the chief indication for treatment, and is generally success- ful. Irritable heart is, in my belief, in some cases a symptom of neurasthenia (q.v.). 3. Various Nervous Causes, such as fright, fear, or other emotion, especially after an exhausting illness, give rise to palpitation (compare Paroxysmal Tachycardia, § 40). 4. In Anaemia the palpitation is a frequent and often distressing feature. 5. In Dyspepsia palpitation is very often present. In such cases it frequently occurs at night, especially after taking a heavy meal. It may, in these circum- stances, be accompanied by morbid dreads—e.rj., of impending death—by breath- lessness, cardiac pain, and by other cardiac symptoms. 6. Certain Local Conditions, such as thoracic or abdominal tumour, or dilated stomach, which hamper the heart’s action, may produce palpitation, although the heart be healthy. 7. The excessive use of Certain Drugs or Articles of Diet, notably tobacco, tea, coffee, and alcohol. 8. In Graves’ Disease (exophthalmic goitre) violent palpitation and greatly increased rate of the heart are prominent features. In quite a number of my cases this and the other nervous symptoms of the disorder had existed for many months, or years, before the two diagnostic features—thyroid enlargement and exophthalmos—became obvious. Graves’ disease should always be suspected in cases of persistent palpitation for which no cause can be made out. 9. In Hysterical subjects palpitation is a symptom often complained of, and occasionally it takes the form of a definite and somewhat alarming attack (see a case, § 40). § 23. Pain in the Chest is not always present, even in grave cardiac disease. A feeling of discomfort or constriction, or a sense of suffoca- tion, is a symptom frequently present when the action of the heart is deranged by functional or structural diseases—oftener perhaps by’ functional. To avoid certain fallacies, ascertain if there be tenderness on pressure. If so, the lesion is probably a neuralyia of the intercostal nerves, or the inframamrnary pain so common in hysteria. The latter may sometimes be distinguished in this way from pain of cardiac orgin, but