Definition and various Forms of Disorder – Pathological Relations and Causes – Association with other Diseases – Symptoms, Physical Signs of – Diagnosis – Prognosis – Treatment – Cases.
GENTLEMEN : I propose to take up the Diseases of the Heart in the following order (1) Functional (2) Inflammatory. (3) Organic. This lecture will treat of Functional Disorders of the Heart.
A purely functional disorder of the heart is any disturbed action occurring independently of either inflammatory or organic affection. These affections may be attended by more or less functional disorder, but there are many cases where the latter are unattended by any lesion or inflammation.
In most cases, the disturbed action of the heart is evidently due to morbid conditions seated elsewhere, but it may be symptomatic of either blood-changes, or affections of the nervous system, or of both.
It must be borne in mind that disordered function of the heart, in cases of inflammatory or organic affections, involves the same morbid conditions which often exist independently of these affections.
The subject of functional disorder of the heart is of great practical importance, on account of the frequency of its occurrence, the anxiety which it occasions, and the liability of confounding it with organic disease.
The majority of persons who complain of symptoms referable to the heart, suffer from functional disease only. But the discrimination of functional from organic affections can only be made by one who is thoroughly acquainted with the subject. The great importance of a correct diagnosis is obvious, when we consider that structural lesions involve more or less danger, while functional disorder, although very distressing, very rarely, if ever, proves serious.
There are several varieties of functional disorder. In the mildest form the action of the heart is simply increased by transient exciting causes, such as mental emotions, unusual exertions, etc., but this excited action is only transient.
Persisting inordinate action is another form. The heart may act with regular rhythm, but with abnormal rapidity and force, not greatly influenced by exciting causes; and this action may continue for weeks and months. The pulse, in such cases, ranges from 120 to 130 per minute, and the patient is in a state of constant anxiety, fearing organic heart disease.
Paroxysms of irregular and tumultuous action is another form of this disorder. Such paroxysms often occur without any obvious exciting cause, and the patient is attacked suddenly with violent beating of the heart, with disturbed rhythm. A feeling of impending death is experienced, with great terror and anxiety, which increases the intensity of the paroxysm. The slightest motion increases the anxiety and palpitation. (Digitalis.)
The attacks may occur at short intervals, or only once in a few weeks; they may last but a few moments, or several hours. Such cases are frequently met with in hysterical women, and are accompanied by various attendant symptoms. Boullard calls this affection an “insanity of the heart,” but it has appeared to me to act more like a choreic affection, such as we observe in muscles elsewhere.
Another species of paroxysm is irregularity and intermissions, without increased force of the heart’s action; on the contrary, the action of the heart may be quite feeble. Such paroxysms inspire great terror. The patient feels as if the slightest movement would cause death, from stoppage of the heart’s motion, or from syncope. (Gelsemium.)
It must be remembered that some cases of mere intermittency are congenital, and are of no importance as a symptom.
In other cases the pulse may intermit, but not the heart’s action. This is termed a false intermission. The force of the ventricular contraction is not sufficient to produce a radical pulsation.
CAUSES AND PATHOLOGICAL RELATIONS OF FUNCTIONAL DISORDER OF THE HEART.
These may be enumerated as follows: plethora, anaemia, derangement of the nervous system, dyspepsia, and the gouty diathesis.
Plethora is that condition in which the blood is abnormally rich in red globules, and, perhaps, in excess as regards quantity. The heart becomes overtaxed and overstimulated, and becomes morbidly irritable. There is much violence of action without much disturbance of rhythm. Palpitation may be the first symptom that awakens the anxiety of the patient, and concentrates his attention on the heart. He becomes fearful of organic disease, and taxes the patience of his medical attendant to a high degree. Those who suffer most from this affection are men who leave the farm or workshop, and men of previously active business pursuits, who change their mode of life and become luxurious, indolent, or lead sedentary lives. Women who tend to obesity and live much indoors are liable to this form of heart disorder.
Anaemia, or an opposite condition to the above, is more frequently met with, and rarely occurs without more or less disturbance of the heart’s action. Women are more subject to this variety than men. Anaemia being produced by excessive loss of blood, or of any of the fluids of the body, the first cause may generally be located in some particular organ or tissue. It must be borne in mind that the heart disorder is not always proportionate to the anaemia. It may be slight in cases of marked anaemia, and severe when the condition is hardly appreciable.
With the anaemia, besides the functional heart disorder, we shall find coldness of the extremities, headache, neuralgia, melancholy, irritability of temper, etc. Anaemic patients, with heart symptoms, live in constant dread of organic disease, and fear of fatal results. If the physician trusts altogether to symptomatic phenomena, he may have the same fear of serious results in his patient, for in these cases palpitation is excited by the slightest exertion; dyspnoea is experienced, the countenance is morbid and occasionally dropsy sets in, which may be mistaken for the dropsy caused by organic disease.
Derangements of the nervous system may be a cause of functional disorder of the heart, without the presence of anaemia. Cases of hysterical palpitation come under this head, for hysteria often occurs without anaemia, but with plethora.
A condition of the nervous system favorable to functional disorder is said to be caused by masturbation and venereal excesses. Uterine disorders are a prolific cause. The excessive use of tobacco, green tea, and coffee often induce a condition giving rise to functional disorder of the heart.
Whatever may be the causes of this condition, mental depression is a constant attendant (in marked contrast to chronic pulmonary affection). The patient persists in believing that he has organic disease, inspite of our most earnest assurances. He watches the action of the heart with constant anxiety, and habitually counts his pulse, and feels for the beating of the heart, and lives in such a morbid state, mentally, that the condition of the heart is actually aggravated by his constant dread and apprehension.
Dyspepsia, in its various forms, tends directly to cause this disorder, but as many dyspeptic ailments proceed from derangement of the nervous system – and this often induced by mental distress or anxiety – it is often difficult to separate this cause from those gastric affections proceeding from indigestion or hepatic derangement.
Dyspeptic patients with heart disorder are equally prone to magnify it into a dangerous complaint. They watch the pulse and the beating of the heart, and are in dread of sudden death, such as they have heard of in organic disease. It is notorious that this morbid watching for heart-symptom, and the anxious expectorations of finding heart disease, is actually sufficient, in some cases, to produce the functional variety. The presence of gas in the stomach, even when dyspeptic symptoms are not present, often causes severe attacks of palpitation. In such cases, the expulsion of a quantity of wind by belching often puts an end to the distressing paroxysm.
The gouty diathesis gives a liability to functional derangement of the heart’s action. Attacks of palpitation occur in such persons before the joints are affected, and cease when tumefaction is present. The presence of an undue quantity of lithic acid in the blood is supposed to be a cause – acting aS an irritant to the nerves which control cardiac action.
Other causes of functional disorders have been noticed by clinical observes. It occurs during convalescence from fevers. Deformities of the chest seem to favor it. Young persons whose growth is rapid are liable to it. Excess in muscular exercise induces it. Soldiers in the late civil war were affected with it, probably caused by the excitement and muscular exhaustion incident to their life.
FROM WHENCE COMES CARDIAC INNERVATION?
This is an interesting question, both in its pathological and therapeutic relations. Barthez* * Traits de Therapeut., vol. 1, p.48, par Trousseau and Pidoux says we must make a distinction between the radical and the acting forces governing the heart. The former may be nearly exhausted, while the latter are in full play; and, vice versa, the latter may be but slightly manifested, while the former are powerful. The amount of radical forces represents a person’s capacity of vital resistance to disease and fatigue. The acting forces have their origin in the radical. In cases of functional disorder we have hyperaesthesia from debility, or a morbid stimulus may be reflected from the nervous centres on the cardiac nerves.
Hale wrote Lectures On Diseases Of The Heart, Materia medica and special therapeutics of the new remedies Volume 1, Materia Medica And Special Therapeutics Of The New Remedies Volume 2, Saw Palmetto: (Sabal Serrulata. Serenoa Serrulata), The Medical, Surgical, and Hygienic Treatment of Diseases of Women, New Remedies: Their Pathogenetic Effects and Therapeutic Application, Ilex Cassine : the aboriginal North American tea, Repertory to the New Remedies with Charles Porter Hart, The Characteristics of the New Remedies, Materia Medica and Special Therapeutics of the New Remedies, The Practice of Medicine, Homoeopathic Materia Medica of the New Remedies: Their Botanical Description etc.