Angina Pectoris, sometimes called Heart-stroke or Breast-pang, is characterised by intense pain, accompanied by a sense of constriction, which occurs in paroxysms, beginning at the breastbone and radiating thence in different directions, but chiefly towards the left shoulder and arm. It causes profound anguish and extreme dread, which are shown in the countenance of the sufferer by lines expressive of anxiety and terror; the face becomes pale and drawn, and the extremities are cold; there is a feeling of impending suffocation, and yet the breathing is shallow, for the patient fears to make any movement, and remains in a fixed position, lest he should add to his distress; in many instances, the pulse is small and hard. The attack gradually passes away, or may end in syncope, which is sometimes fatal. There are at times premonitory symptoms, such as nausea or faintness, but usually these are absent. It may appear without any apparent exciting cause, but more commonly the paroxysm follows some unwonted strain on the system, as, for example, excess in eating or drinking, muscular exertion, and mental emotions.
Angina Pectoris is associated with many different morbid conditions, amongst the more common being inflammations and degenerations of the heart and aorta, diseases of the valves, and of the nutritive arteries of the heart. In some cases the pain is caused by inflammation of the nerves of the cardiac plexus, which has extended to them from the heart or aorta; in others, it seems to be due to neuralgia, resulting from interference with the cardiac nerves by degenerative changes in the coronary vessels which accompany these nerves; in others, again, it may be induced by want of nutrition of the heart and its nerves through the diminished blood-supply caused by calcification of these coronary vessels. It has been noticed that the pulse is small and hard—that is, it is of high tension—in many cases, and this speaks of a condition of tonic contraction of the heart and arterioles. However produced, the pain originates in the terminal branches of the cardiac plexus of nerves, and is thence conducted by the sympathetic and pneumogastric nerves to the centres of sensory perception, sometimes involving in its course the cervical or brachial plexus, and thus causing the extension of the affection to the shoulder or arm. The treatment of this disease requires before all else that the patient should shun excesses of every kind, and avoid over-exertion of body or undue mental excitement. During the attack, it is absolutely necessary to adopt measures which will promptly relieve the suffering, and amongst such means the most useful are the hypodermic injection of morphine and the inhalation of ether or chloroform; in those cases which have high arterial tension, the inhalation of nitrite of amyl acts like a charm by dilating the arterioles. During the intermissions, the administration of the bromides and iodides has proved useful, and in cases where the tension tends to rise, nitro-glycerine should be given, as it acts in a similar manner to nitrite of amyl, but more slowly and continuously. It is a matter of importance for the patient to have the necessary remedies at hand, and he should invariably carry them about with him.