HEART DISEASES: DIAGNOSIS - PALPITATION
Palpitation is one of the most commonly occurring irregularities to be noticed by the patient himself, and it may be well to attempt to clarify its significance. The patient feels that his heart is beating too rapidly and too violently, and there is an accompanying feeling of tumult and oppression in the upper chest. In nervous subjects, this distress may become almost unbearable, and fear is so great a factor that cause and effect become closely interwoven. Women are more often affected than men, and although it may accompany serious heart disease, it is often found in people whose hearts are perfectly healthy. It occurs in two quite distinct situations: most often induced by exercise or exertion to which the individual is unaccustomed; less often for no apparent reason, while the individual is quiet.
Where induced by unusual strain, the heart is mildly distressed, and there may be alarming accompanying symptoms of breathlessness and faintness even muscular tremors and nervous anxiety. The symptoms disappear with rest, but are liable to recur if the exertion is repeated. However, despite the seeming severity of the symptoms, there are no truly serious signs of cardiac inadequacy such as gross oedema (dropsy) or cyanosis (bluish complexion). The typical subject is young, of rather poor physique and with a depressed and inactive rib-cage. More regular exercise and the development of a well-raised and freely expanding chest will usually go far towards eliminating recurrence. Starchy and sugary excess in the diet, also the use of tobacco or alcohol, or taking much liquid of any kind, are likely to be significant causative factors.
The kind of palpitation that occurs without previous exertion and quite often even after an interval of rest has a less serious import. It can be likened to a kind of carelessness, or lack of discipline, in the heart muscle. Instead of the normal closely regulated rhythm and symmetrical action, the two sides of the heart tend to go their own way and out of step. The effect is of a much increased busyness, and also of great internal tuggings as adjacent fibres try to move in different directions. Unlike the type described above, this form of palpitation is characterized by its immediate cessation upon making any kind of effort even taking a few full breaths. When called upon to meet a real need, the heart muscle snaps back into regular action.
The two forms may have in common a lack of self-discipline within the heart, but in the one case it is due to dismay at an unexpected demand and in the other to a brief neglect of duty.
Cardio & Blood
Diagnostic investigations: clinical laborotarytests - special investigations - coronary angiography - to what use is the information obtained on coronary angiography put to ? if bypass surgery is not considered necessary or if the patient is not prepared to consider surgery at all, should he undergo coronary angiography ?
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