( Originally Published 1921 )
In some instances people with heart trouble suffer great pain in the chest, and this pain is so severe and peculiar that it has received the name of angina pectoris. Indeed, the pain is often the one sign of this disease because it occurs in persons who, if they did not have it, would seem to be perfectly healthy, as well as in people with well-marked heart disease. This pain always comes in spasms and often occurs quite suddenly, tho some sufferers have a premonition that it is coming.
It affects older people more often than younger people. Some form of exertion generally brings on the attack. It is hard to describe the nature of the pain, but all unite in saying that it is beyond description. They describe it as a feeling of oppression and tightness in the chest as if the breast bone was being pushed back to the spine, and in many cases there is a sense of impending death. This is described not as a fear of death but as if death were surely coming.
The pain usually begins in the region of the breast bone, and is apt to travel toward the left.
It involves the left shoulder and the inner side of the left arm. If there have been repeated attacks, the character of the pain is often different ; it involves the throat ; and there remains a soreness of the skin.
When it comes to a consideration of treatment, I find much help in the use of nitroglycerin 1 and allied drugs. This will relieve the attacks of a certain number of patients, and, if given when the attack is impending, will prevent it from coming. When nitroglycerin fails, the use of alcoholic stimulants sometimes helps. In severe cases, morphine must be used hypodermically. Sometimes it is necessary to use a considerable amount of morphine, but it is better to give small doses at a time. In giving a hypodermic injection in angina pectoris, it is better to inject it into a muscle rather than under the skin, because the drug so administered is absorbed and the effect obtained much more quickly. After a severe attack the patient.. should rest quietly for several days.
The best medical thinkers of today tend toward the belief that the origin of angina is in the heart muscle, and that the only chance of preventing it is in treating the heart. A person who is subject to attacks of angina can be helped considerably by strict attention to diet and exercise, and by limiting all activities that tend to raise blood pressure.
It is particularly important that all people with heart trouble who suffer pain in connection with it should receive careful attention, because they are often, the ones who later on develop attacks of this terrible malady.
The person who has care of a patient subject to angina pectoris should obtain careful instructions as to how to act in emergencies. She should not neglect the simpler methods of relieving pain, such as the application of a hot water bottle, etc. ; but in such cases she should have the authority of the physician to use the hypodermic when necessary, if the case is a severe one and other remedies have failed to relieve in a reasonable length of time.