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( Originally Published 1921 )

Palpitation of the heart is the name given to attacks that come on by day or night, often suddenly. The person who has the attack suddenly flushes up ; there is distress in the chest, and the heart becomes exceedingly rapid. True palpitation is always of this character, tho slight disturbances with intermittences of the pulse and fluttering of the heart may happen in less well-defined attacks. Sometimes the person describes a feeling as if the heart turned over in the chest.

Palpitation is often a sign of serious disease; again, it may happen in persons who are upset by indiscretions of diet, abuses of tea or tobacco, or in those who are enfeebled by lack of exercise or other debilitating conditions. Palpitation of a troublesome kind is often seen in people who have hardening of the arteries, and when these attacks are accompanied by wind on the stomach and indigestion, the' true cause may be overlooked, but the attacks are never overcome till the hardening of the arteries is treated.

A person who is subject to attacks of palpitation should build up his general health in every way, and having found the cause of these attacks should seek to have it removed.

There are some cases, however, in which there does not appear to be any discoverable, under-lying cause. This seems to happen most often in families in which nervous tendencies are a characteristic; it also seems more apt to occur in people with low blood pressure. The at-tacks often terminate suddenly, and a curious fact is that during the attack the pulse is frequently exactly twice as rapid as it is in the intervals.

There is no satisfactory treatment for an at-tack of palpitation; sometimes the attack yields to a certain treatment; another time, when the same treatment is tried, the attack continues. Among the things to be tried are the drinking of cold water, deep respirations, changes of position from standing up to lying down, lowering the head, etc. emetics, bromide of ammonia, bicarbonate of soda, or an ice bag over the heart.

If the attacks can be traced to other conditions, of course, these are to be treated. Such palpitation may occur after typhoid fever, in which case particular care should be exercised, and the heart should be examined later to see if any permanent damage has remained from the fever. When palpitation occurs after an attack of diphtheria, it may be serious.

In heart disease proper a rapid pulse is frequently observed. Persons who are subject to palpitation learn by experience what helps the most. The attacks seldom last more than a few hours, and it is better to remain perfectly quiet and wait for the attack to pass off. These at-tacks are not ordinarily dangerous tho, of course, they are alarming.

Any one who has charge of the nursing of a patient with palpitation of the heart must learn to reassure the sufferer and patiently apply the various remedies already suggested ; but a physician should always be summoned unless one has already given instructions.

The important thing to learn about palpitation is that it must not be allowed to interfere with attention to the general health of the patient. Thus, I have seen a patient, subject to attacks of palpitation of the heart at frequent intervals, kept in bed and treated as if the heart was actually weak instead of only misbehaving; meanwhile the attacks became steadily worse. The same patient when driven to enforced exercise out of doors recovered completely, and was almost free from attacks from the first. The responsibility of distinguishing between a weak heart and a misbehaving heart should be placed upon the physician, but it is the nurse's duty to act accordingly.

Some Points in the Dietary of Patients with Palpitation of the Heart: Animal food should be taken in moderate amount, and consist of the lean of meat, game, and poultry. Fish, avoiding salmon and other fatty kinds, is permitted. A small quantity of fat should be taken for health's sake. Farinaceous and starchy foods are reduced, and no sugar is allowed. About five ounces of fluid is the limit with meals, and hot water should be taken between them. Fresh vegetables and fruit are allowed.

In some cases of much difficulty, met with among fat, anemic women, an exclusive milk diet with rest and massage may be necessary first.

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