Indigestion And The Heart
( Originally Published 1921 )
The close relationship between the heart and the stomach has naturally led to the impossibility of separating the two organs on the basis of their disorders. So that it happens that most sensory and motor disturbances of the heart first come under the care of the stomach specialist.
All of us have had experience with sensations arising from the stomach from the simplest sensation of discomfort due to hunger to most violent pain caused by food which should not have been eaten, or, at least, not in the way in which we ate it. Few people, however, have any experience with sensations coming from their hearts. Perhaps when they were young they ran too hard and had a "stitch in the side" or something like that, but nothing more. So, it is only natural that, when sensations are noticed coming from a part of the body occupied by these two organs, the stomach is blamed as the culprit in causing discomfort.
The chest is separated from the abdomen by a thin muscular wall, the diaphragm. The stomach is close up underneath the diaphragm, and the heart rests on top of it. The stomach moves down and the heart moves with it whenever we breathe.
How closely related the stomach and the heart are is often nicely shown by the X-ray picture.. This is a perfectly healthy person who has eaten fast and swallowed air with his food and at the same time taken a large quantity of fluid. The stomach is filled with fluid and a little air on top of it, and the heart is beating rapidly because the man had just exerted himself. You can see in the picture how the contents of the stomach are being agitated by the overacting heart. This gives a good idea of how close the two organs are together, and how interdependent they are in producing disagreeable sensations. This makes it difficult for the sufferer and also for the doctor to decide whether the pain really comes' from the heart or from the stomach. There is no absolute, guide, but, in general, pains that come from the heart have a tendency to spread upward to the left shoulder and the left arm, and if they are really important they ordinarily extend as far as the hand and wrist. The stomach pain sticks pretty close in one place, and is relieved when the stomach is emptied.
The true and severe heart pain almost always results in the weakening of the stomach, for the time being, so that it is quite sure to become more or less distended by gas. For this reason attacks of angina pectoris are usually accompanied by wind on the stomach. When the attack of heart pain is relieved, the spasm of the stomach is relieved at the same time, and the gas is often expelled.
To weigh properly the importance of severe pain in the region of the stomach and to decide whether it is purely of stomach origin or is also of heart origin requires close study, and must be founded upon a thorough examination of the heart between the attacks to find out whether it is sound or not. Sometimes an attack which has proved to be purely of stomach origin will in time cause profound disturbance of the heart rate. Ordinarily the heart becomes rapid, but sometimes it becomes slow. A good test is the use of nitroglycerin as a remedy for heart pain. If the pain is promptly relieved by nitroglycerin, it is fairly safe to say that it was really a pain in the heart.
It is necessary that people should understand these things, and . not expect the physician to decide on the spur of the moment what is really a difficult question. It would be much better if they would trust entirely to their physicians and not require them to express premature opinions.
If every one could be under the care of a doctor whom he trusted, it would be preferable; but we fear that this is too much to expect. The object in writing this book, which is meant for the public, is to furnish a guide for those who are particularly interested in people who are liable to heart attacks, and enable them to act intelligently. We do not mean that the physician should not be consulted and kept as much as possible m charge; we aim rather to assist the sufferer to. derive the utmost benefit from his physician by the ability to exercise an intelligent cooperation.