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Palpitation of the Heart.One of the most common symptoms during such an attack is the patient's dread of impending death, due partly to the un pleasant sensations which he experiences, and in part, doubtless, to his conviction that he has heart disease. It may be said, once for all, that palpitation of the heart, however distressing and un pleasant it may seem, is usually quite independent of organic dis ease of the heart, and, in such cases, contains no element of danger. The causes of this palpitation are several. Slight attacks often occur in those especially addicted to the pleasures of the table, particularly if they take but little exercise. It is often doubt less the result of excessive indulgence in liquor, venery and tobacco; and it is highly probable that addiction to strong tea and coffee may be followed by the same disorder of the heart. So, too, in some individuals it occurs from exhaustion, whether from physical effort or from mental strain or anxiety. In girls it is a not infrequent accompaniment of the green sickness, chlorosis, and of hysteria. The first point in the consideration of palpitation of the heart, is to determine whether it be due to one of these causes, which we may distinguish as nervous, or whether it be actually associated with organic disease of the heart. It may be said in general terms, that the latter condition is a comparatively rare one as a cause of palpitation; that the great majority of cases of so-called palpitation are purely nervous, and not dependent upon any actual disease of the heart. The truth can be ascertained at once by a careful exami nation of the heart with the stethoscope; and it is very desirable for the sake of the patient, to learn whether any such disease of the heart actually exist. Yet, even without such an examination by% a physi cian, it will be usually found that a distinction can be made in this way : Nervous palpitation is apt to occur especially at night soon after the patient retires, while palpitation from organic disease occurs most frequently after physical exertion. Nervous palpita tion is usually accompanied by other symptoms of nervousness, increasing whenever the patient's mind is disturbed, and rather diminishing when his attention is engrossed by actual physical exercise ; organic palpitation is not associated with mental so much as with physical causes. " It is extremely desirable, in view of the comfort and welfare of the patient, to determine with positiveness, in cases of func- tional disorder, that structural disease does not exist. If, on a careful examination of the chest, the heart be not found to be en larged, if there be no murmur present, and the heart sounds be normal, the affection may be confidently pronounced functional (nervous); without the negative proof afforded by examination of the chest, the mind of the practitioner must be in doubt as to the diagnosis. If he give a decided opinion, it is a guess which may prove to be either right or wrong. If he avoid giving a decided opinion, the inference which the patientk usually draws is that organic disease exists, and that the physician is reluctant to tell him the truth. I could cite from the cases which have come under my observation, not a few in which patients were for many years rendered unhappy and deterred from engaging in the active duties of life, by either an erroneous medical opinion that they had organic disease of the heart, or by a fixed belief that such was the fact, based on the indecision of their physicians." After it has been decided that the disease is really not located in the heart, but that the palpitation is merely an evidence of a nervous disorder, the treatment will of course consist in discovering and removing the cause of the nervousness. In most cases it will be found necessary to regulate the amount of food, and to carefully avoid excesses of all kinds, including tea, coffee and tobacco; pro vision should also be made for a proper amount of outdoor exer cise and for mental recreation. Not the least important item in the treatment consists in the positive assurance to the patient that he is free from " heart disease," properly so-called. He should also be assured that there is no danger of a genuine heart disease arising from repeated attacks of nervous palpitation. Many cases will doubtless resist treatment for a long time, especially if they have existed for many years. Perhaps the most promising cases are those in which the disease is evidently a result of impoverishment of the blood,-anæmia - as is so often the case in girls and women; for in these instances the anæmia can usually be relieved and the palpitation stopped. During the paroxysm of palpitation relief can often be obtained by the use of stimulating liniments, such as the chloroform liniment over the chest, and by the inhalation of hartshorn and similar agents. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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