The onset is sudden and usually without any warning. Remember the three essential phenomena: 1. Pain, agonizing, felt in the precordium and beneath the manubrium. The pain radiates to the neck and into the left arm along the distribution of the ulnar nerve. 2. The sense of constriction of the heart — feeling as though the heart were being 'grasped by a mailed hand.' 3. The sense of impending death. The face is pallid, gray, and bathed in sweat. Remember that death may occur during an attack. Remember that paroxysms may occur frequently or at long intervals of time. Remember that there is a neurotic form that closely simulates true angina. Remember that the neurotic form occurs more frequently in women — periodically; that the attack lasts one or two hours, during which there is agitation and activity, associated with nervous symptoms, and is never fatal.
Treatment During an Attack: Nitrite of amyl by inhalation frequently gives relief; from 3 to 5 minims on handkerchief or sponge may be inhaled. Patient should carry the 'pearls,' and be instructed to break one and inhale from handkerchief on first signs of an attack. Chloroform inhalation should be resorted to if amyl nitrite inhalations do not give relief. Usually this is the most effective way, and it is free of danger. Morphin hypodermatically may be used, but bear in mind that it requires a large dose to give relief. Give at least gr. ^-gr. ss combined with atropin sulphate gr. M.00.
Interval Treatment: Patients should live a quiet life, free from worry and excitement. Muscular exertion must not be sudden or prolonged. Substances that, in the course of time, have a toxic action on the heart must be avoided, as these substances may be the cause of severe attacks of angina. This is particularly true of tobacco, and the peculiar thing about it is that the patient may use tobacco for years without any apparent ill effect until, arriving at midlife, it begins to manifest its toxic action. Tea and coffee are likewise harmful, and should be excluded.
Elimination: Elimination is exceedingly important in the treatment. Toxic substances absorbed from the bowels are, without doubt, potent factors in causing high blood pressure and vascular sclerosis. Many of the cases give a history of dyspepsia of long duration. Diet is, therefore, important, and should be light and nutritious. An exclusive milk diet for a while is excellent. Cream should be added to the milk. Fresh vegetables and fruits are indicated. Eggs, butter, and the lean of fresh meat minced and lightly cooked may be allowed. Regular evacuation of bowels is very essential, because it will check the formation of injurious substances.
Nitroglycerin: Nitroglycerin should be given for its relaxing action upon the blood vessels; it may be given in doses of gr. %oo and gradually increase until effect. Spirits of glonoin may be used, which represents Yioo grain of nitroglycerin to the minim. Begin with 1 minim three times daily and increase 1 minim every fifth day until the patient complains of flushing or headache.
Iodids: Iodids, either the potassium or sodium, administered for one or two years, stopping ten days in each month, are excellent.
Arteriosclerosis: Remember that the history of the patient gone into carefully often reveals the cause. Syphilis, gout, arthritis, and heredity are the chief causes. Remember that this is a change common to old age, and is similar to the sclerotic changes of other tissues.
Treatment for Arteriosclerosis: Early diagnosis is necessary if anything of permanent value in treatment is to be done. Diet should consist largely of milk and its products, with vegetables and fruits. Meat should be reduced to the minimum. A quiet life, free from worry, and moderate open air exercise is indicated. Baths of room temperature or sponging is excellent. Massage of the abdomen and extremities, if long continued, will lower the blood pressure. The bowels should be kept open by vegetable or saline cathartics. The kidneys must be kept active.
Diuretics: For this purpose theobromin is useful.
Arsenic and Iodine Treatment: Arsenic may be exhibited as Fowler's solution, or as in the following:
If cardiac insufficiency manifests itself, tonics are indicated, and of these perhaps tincture of digitalis in 10-minim doses, combined with 1 minim of spirits of glonoin, three times daily, or of tener if the symptoms are urgent. Venesection, with abstraction of 20 ounces of blood, gives immediate relief in cases of engorgement. The amount of blood withdrawn should not be replaced with the saline solution, as it is the reduction of the circulating liquid that is desired.
<Callout type="important" title="Critical Symptoms to Recognize">Recognizing the symptoms of angina pectoris early can save lives. Immediate relief measures are crucial.</Callout>
<Callout type="warning" title="Avoid Toxic Substances">Substances like tobacco, tea, and coffee should be avoided as they exacerbate heart conditions.</Callout>
Key Takeaways
- Recognize the three critical symptoms of angina: severe chest pain, constriction feeling in heart, and impending death sensation.
- Use nitrite of amyl or chloroform inhalation for immediate relief during an attack.
- Maintain a diet low in harmful substances like tobacco, tea, and coffee to prevent exacerbations.
Practical Tips
- Carry 'pearls' (amyl nitrite capsules) at all times if you are prone to angina attacks.
- Regular bowel movements can help eliminate toxic substances that contribute to high blood pressure and vascular sclerosis.
Warnings & Risks
- Avoid sudden or prolonged muscular exertion as it may trigger an attack of angina pectoris.
- Do not use morphine without proper medical supervision due to the risk of overdose.
Modern Application
While some treatments like nitroglycerin and lifestyle modifications remain relevant, modern medicine offers more advanced diagnostic tools and medications. Understanding historical methods can still provide valuable insights into symptom recognition and initial management.
Frequently Asked Questions
Q: What are the three essential phenomena of angina pectoris?
The three essential phenomena include severe chest pain felt in the precordium and beneath the manubrium, a sense of constriction or 'grasping' feeling around the heart, and an overwhelming sensation of impending death.
Q: How can one manage angina pectoris during an attack?
During an attack, nitrite of amyl inhalation is recommended. If this does not provide relief, chloroform inhalation should be used as it is highly effective and safe compared to morphine.
Q: What dietary changes are advised for patients with arteriosclerosis?
Patients should adopt a diet rich in milk products, vegetables, fruits, and lean meats. Reducing meat intake and avoiding harmful substances like tobacco, tea, and coffee is crucial to prevent exacerbations.