Cardiac Neurosis Research Articles

Foreign bodies in and in relation to the thoracic blood vessels and heart III. Indications for the removal of intracardiac foreign bodies and the behavior of the heart during manipulation

Evidence is presented in support of the following indications for the removal of some intracardiac foreign bodies: (1) to prevent embolus of the foreign body or associated thrombus, (2) to reduce the danger of bacterial endocarditis, (3) to prevent recurrent pericardial effusions, and (4) to diminish the incidence of myocardial damage. The additional factors of pain and cardiac neurosis are also considered. The behavior of the heart during various types of manipulation is described. Dislocation of the heart from the position of optimal function is poorly tolerated, as are other procedures which upset cardiovascular dynamics by obstruction to blood flow.

Cardiac and Respiratory Neurosis after Contusions of the Chest‐Wall.1

Cardiac and Respiratory Neurosis after Contusions of the Chest‐Wall.¹

Glucose deficiency as a factor in the production of symptoms referable to the cardiovascular system

Disturbed carbohydrate metabolism may precipitate various manifestations referable to the cardiovascular system. These manifestations can be recognized by their appearance two or more hours after meals, their relief by the ingestion of glucose, and their reproducibility by administering insulin. When the symptoms are present, the blood sugar level is usually within the lower limits of normal, or only slightly subnormal. The disturbance of carbohydrate metabolism which is responsible for these symptoms has, for want of a better term, been designated as “relative hypoglycemia.” Relative hypoglycemia is a common factor in the production of symptoms referable to the circulatory system, and has been found in thirty-one of the last two hundred four of our patients with cardiovascular complaints. Relative hypoglycemia may produce subjective and objective manifestations identical with those commonly observed in patients with cardiac neurosis. The two conditions can be differentiated only after the most thorough study, and they frequently coexist. Relative hypoglycemia may be a “trigger” factor in precipitating various arrhythmias (including paroxysmal tachycardia), as well as attacks of angina pectoris, hypertensive encephalopathy, carotid sinus syncope, and circulatory disturbances associated with the menopause. Relative hypoglycemia frequently is associated with pain in the chest which is nonanginal in character. Occasionally it induces, in patients with typical effort angina, attacks of angina pectoris at rest. Rarely patients without any evidence of structural cardiac disease may have, as the result of glucose deficiency, attacks of severe pain which are identical with seizures of angina pectoris in all respects except for the absence of a relation to muscular effort. The circulatory manifestations of relative hypoglycemia are the same as those observed after the experimental or therapeutic administration of insulin. They appear to be related to two mechanisms: release of epinephrine, and alterations comparable to those which occur in anoxia. The increased venous return, so brought about, causes an augmented cardiac output and the typical signs of the “overactive heart.” The diagnosis of the milder instances of relative hypoglycemia has been discussed, and it is concluded that the attempt to reproduce the symptoms in a given case by insulin administration is, in certain patients, a more valuable method than the glucose tolerance test. Both methods are less important than the history. When relative hypoglycemia is causing symptoms, marked benefit can usually be obtained by the use of a diet which is poor in carbohydrates and rich in protein, with intermediate feedings. Observation of the response to such a diet is therefore at times a helpful diagnostic measure.

Conditioned cardiovascular responses and suggestions for the treatment of cardiac neuroses.

Conditioned cardiovascular responses and suggestions for the treatment of cardiac neuroses.

Cardiac neurosis associated with organic heart disease

Cardiac neurosis associated with organic heart disease

THE GROWING IMPORTANCE OF CARDIAC NEUROSIS

Article1 May 1937THE GROWING IMPORTANCE OF CARDIAC NEUROSISPAUL D. WHITE, M.D., F.A.C.P., R. EARLE GLENDY, M.D.PAUL D. WHITE, M.D., F.A.C.P.Search for more papers by this author, R. EARLE GLENDY, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-10-11-1624 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptI. IntroductionII. Case histories of patients with cardiac neurosis, with and without heart diseaseA. Neurosis predominatingCase 1. Neurosis Induced Largely by Neurocirculatory Asthenia. Normal Heart.Case 2. Neurosis Initiated by Paroxysmal Tachycardia. Normal Heart. Case 3. Neurosis Induced by Sudden Knowledge of Compensable Heart Disease While in Army. Rheumatic Valvular Disease.Case 4. Neurosis Following Coronary Thrombosis.B. Heart disease predominatingCase 5. Severe Coronary Heart Disease Masked by Psychoneurosis and Morphinism.III. Summary and conclusionsI. INTRODUCTIONThe more heart disease there is, and especially the more widespread the publicity about it, the more important becomes...Reference1. GLENDYWHITE REPD: The recognition and treatment of cardiac neurosis, Med. Clin. N. Am., 1937, Boston number, p. 449. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston, Massachusetts*Received for publication March 3, 1937.From the Cardiac Clinic and Laboratory of the Massachusetts General Hospital. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byUnmasking the true face of postural orthostatic tachycardia syndromeZinkThe Importance of Recognizing Post-Infarctional Shoulder-Hand Syndrome 1 May 1937Volume 10, Issue 11Page: 1624-1635KeywordsCardiovascular therapyCoronary heart diseaseHeartHeart diseasesHospitalsResearch laboratoriesTachycardiaThrombosisValvular diseases Issue Published: 1 May 1937 PDF downloadLoading ...

The Recognition and Treatment of Cardiac Neurosis

The Recognition and Treatment of Cardiac Neurosis

The Cigarette Habit

AT a meeting of the Society for the Study of Inebriety and Drug Addiction on April 12, a paper on the cigarette habit was read by Dr. J. D. Rolleston, who dealt with its history, economics, pharmacology, and clinical aspects. Cigarette smoking appears to have originated in South America, where it was reported by travellers and missionaries in the eighteenth century, and thence to have been introduced to Spain, where it was described by Casanova in a visit to Madrid in 1767. The cigarette was afterwards introduced into France and Italy, but it was not until after the Crimean war (1856), when French and English officers acquired it from their Turkish allies, that the cigarette habit became diffused over Europe. Germany, where the cigar was more popular, was among the last European countries to adopt the cigarette; it did not become firmly established in England until the ‘eighties. There has been a great increase of cigarette smoking since the War, especially among women, in all European countries and the United States. Dr. Rolleston pointed out that the cigarette differs from other preparations of tobacco in its nicotine content being lower than that of the cigar or pipe, whereas the amount of carbon monoxide in cigarette smoke is comparatively high. Furfurol, which is usually absent in the smoke of the pipe and cigar and present in only very small amounts in that of the Turkish cigarette, is found in comparatively large quantities in the smoke of the cheaper kinds of Virginia cigarettes and is liable to give rise to symptoms of intoxication. Medical opinion is still divided as to the part played by tobacco in general and the cigarette in particular in the causation of certain diseases, such as angina pectoris and cancer in various situations, and the risk of laryngeal involvement in smoking by tuberculous patients. General unanimity, however, seems to prevail as to the injurious effects of smoking by the young or by the subjects of cardiac neurosis or peptic iilcer.

Application of d'Arsonval's currents and diathermy in cardiac pains. Rogachevsky (Physiotherapy, 1928, No. 1)

On the basis of a large amount of material, the author came to the conclusion that d'Arsonval's currents have a pain-relieving effect, and their use is desirable in the following cardiac diseases: cardiac neurosis, heart defects, minor myodegenerations and myoasthenia.

On the Minute Volume of the Heart in Hypertension

On summarizing the observations above described, we see that in cases of benign and malignant hypertensions and acute diffuse glomerulonephritis, the minute volume is considerably increased, as compared with the normal standards, and that it diminishes nearly proportionally to the decrease of blood pressure, whilst in cases of the end stage of chronic diffuseglomerulonephritis, i. e. secondary contracted kidney, it remains approximately normal or rather tends to diminish. According to Weizsacker, 9) Liljestrand and Stenstrom, 10) and Dautrebande, 11) anaemia can sometimes give rise to an increase of the minute volume of the heart. The reason why the secondary contracted kidney, which in the majority of cases is accompanied by anaemia, is not increased in the minute volume, is to be sought in the slightness of the anaemia and also in the enfeebled heart function due to emaciation through the prolonged course of the renal insufficiency. Thus it may follow that all the diseases which are accompanied by increased arterial blood pressure do not always produce an increase in the minute volume, as Liljestrand and Stenstrom11) have advanced, and also that the minute volume of hypertension seems to bear no direct relation to the insufficiency of the renal function. It is perceptible that the minute volume of malignant hypertension is usually quantitatively greater than that of benign hypertension, but since the blood pressure of malignant hypertension is generally higher than that of benign hypertension, the difference of the increased minute volume between both the hypertensions will probably depend upon the degree of the increased arterial blood pressure, and the cause of the hypertension in both diseases, having no qualitative difference, will presumably be the same, inasmuch as there are between them occasionally states of transition impossible to discriminate clinically. In the case of nephrosclerosis and acute diffuse glomerulonephritis the minute volume seems to be intimately associated with blood pressure since I have observed that in the fluctuating blood pressure the minute volume runs parallel to the variation of blood pressure, so that we may infer also from this that the hypertension in this disease has a different cause from other renal diseases with raised blood pressure. There are not a few authors who are ready to attribute a factor of non-nephritic hypertension to the increased output of the heart or an increased cardiac efficiency, thus, in patients of cardiac neurosis Hochhaus12) has postulated from the heart systole occurring swiftly and plentifully, that the hypertension in them is due to the increased heart function, and Gross13) has advanced that the hypertension in exophthalmic goiter is provoked by an increased heart function; in several cases of young men with high blood pressure of unknown origin, Kulbs14) has preliminarily attributed its cause to an excessive heart action. One of the factors in which the increased minute volume results may be augmented gas metabolism of the tissue cells, the action of the circulatory system being increased secondarily in order to respond to an excessive demand for oxygen in the tissue. According to my determinations of gaseous exchange in different kinds of hypertensions, as will be reported later in another paper, of nephrosclerosis, malignant hypertension in which the renal function is profoundly disturbed, brings on an increased oxygen consumption, while benign hypertension gives a nearly normal rate of basal metabolism. Thus in malignant hypertension the increased minute volume is supposed to have responded to the change of gaseous metabolism, but in benign hypertension it is based on exaggerated cardiac function of another cause.

Cardiac neurosis associated with rheumatic valvular heart disease

1. 1. Twenty-three cases are reported where cardiac neurosis was associated with valvular heart disease. 2. 2. Suggestion from an anxious mother in three cases and from a doctor in eight cases were important factors in the development of the neurosis. Recognition of these nervous manifestations is of great importance. 3. 3. The recognition and treatment of these cases is important and difficult.

HEART DISEASE IN PREGNANCY

The subject of marriage in girls, and pregnancy, in women with cardiac disease is naturally of vital interest from the standpoint of the obstetrician, the general practitioner and the cardiologist. With reference to marriage in girls with valvular disease, views vary from the extremely narrow one of absolute interdiction in those with any type of heart trouble to the physician's consent to marriage in those with even advanced heart disease. Marriage (without pregnancy) has as its chief dangers the excitement and heart strain incidental to coitus. That this can be a real danger is shown by occasional instances of hemoptysis immediately following coitus in those with mitral stenosis. In those with a tendency to or with actual tachycardia without decompensation, the sexual act may induce or continue a cardiac neurosis superadded on an actual organic lesion. While there is no invariable rule, marriage should not be advised in those who

THE DIAGNOSTIC VALUE OF THE ORTHODIAGRAM IN HEART DISEASE

The orthodiagram has been a disappointment to those clinicians who had hoped to find an accurate estimation of the size of the heart of vise in diagnosis. Particularly in the field of cardiac neurosis and early myocarditis, in which the ordinary diagnostic methods fail to show any enlargement, evidence of a slight enlargement might be expected to have diagnostic or prognostic import. The roentgenogram does not give us such evidence because of the magnification of the cardiac shadow by the divergent rays and because of the lack of definition at the margin, since the heart is in active motion while the exposure is being made. The orthodiagram, however, gives perfectly definite images of a moving organ, allows of the observation of any anomaly of motion, and depends only on the skill of the operator in the interpretation of the images viewed. In addition it leaves a permanent record of

INSPECTION OF THE JUGULAR VEIN; ITS VALUE AND ITS LIMITATIONS IN FUNCTIONAL DIAGNOSIS.A CRITICISM BY DR. HIRSCHFELDER AND A REPLY BY DR. McCASKEY. I. A CRITICISM.

The subject of heart-block and the recent additons to the knowledge of the allied functional disturbances of the heart and of the so-called cardiac neuroses have aroused a great deal of interest in the revelations from tracings of the venous pulse and polygraphic tracings. Although with appropriate apparatus¹these are somewhat less difficult to obtain than are good radial pulse tracings, some form of rather expensive polygraph is necessary, and about half an hour is required to obtain the desired record.²Nevertheless so much information is to be gained by what they show that this procedure can scarcely be omitted from the modern routine examination of heart cases. It is, therefore, natural that efforts should be made to minimize the labor involved in such investigation, and in this regard the recent contribution of Dr. G. W. McCaskey³marks an attempt toward simplicity. By means of the Mackenzie

Review of works on diagnostics, particular pathology and therapy of diseases of the circulatory apparatus for 1901

Ad. Schmidt (321) establishes a connection between the existence of small dilated cutaneous veins in the area of cardiac dullness and along the line of attachment of the diaphragm with some forms of cardiac neuroses.

THE SO-CALLED CARDIAC NEUROSES.

"Cardiac neuroses," so-called, have been attributed as a general rule to disturbances in the normal workings of the nervous apparatus of the heart. In this, as in many other instances, the effort at classification has probably gone beyond our actual knowledge of the nature of the processes in question, because it is not yet clear how much of cardiac function depends on the nervous mechanisms, and how much on the muscle cells of the heart. Just at present physiologists are inclined to lay especial stress on the automatism of the muscle cells and to refuse to attach much if any importance to the nervous influences. In a recent paper by L. F. Barker¹this subject is reviewed from the anatomic, physiologic, and pathologic points of view. It is pointed out that the heart has no nerves at all when it begins to beat in the embryo, and that the