2. Angina pectoris may occur in a Patient who has had dilatation of the heart when the organic condition (dila tation) is removed by treatment. J. IL Musser (Amer. Jour, of Med. Sciences. Sept., '97).
Attention drawn to that form which is found in association with dry pericar ditis: the pain in these eases is situated at the base or middle of the sternum; it may also be in the epigastrium and over the cardiac area. It radiates outward toward the arms. These signs, in truth. afford no differentiating clue. On careful auscultation. however, to-and-fro friction may be heard coincidently with the car diac movements, with hyperresthesia in the przneordial region: and the facts of its frequently following tonsillitis and rheumatic ailments, and not being amen able to the operation of vasodilators and stimulants. serve to distinguish it from most eases of coronary angina: it is an exocardial angina. The treatment of the condition is naturally, that of pericar ditis. M. Pawinski (La Semaine Oct. fi, '97).
Special variety of musical heart-mnr mur, resembling a feeble groan or chirp ing of chickens. Similar eases described by Capozzi, in which a constant lesion was found, namely: a regular perfora tion of a free valve. Case of a man, aged 30, suffering from anginal attacks. Double aortic murmur, the diastolic part of the murmur being musical. The apex beat was in the fifth space, outside the nipple-line. No history of rheumatism. History of syphilis. Death in one of the attacks of angina. At autopsy mitral valves found normal; aortic valves thickened, two cusps being adherent; the third was perforated near the aortic parietes, but not adherent. Coronary arteries healthy. Tecee (La Rif. Med., Apr. 2, '97).
Diagnosis. — In true angina pectoris skilled observers almost invariably find evidence of organic cardiac or aortic le sion. In a supposed case these should be
sought most carefully. Particularly to be looked for are arteriosclerosis, hyper trophy or dilatation of the left ventricle, aortic regurgitation, and feebleness of the muscular power of the heart.
True angina always associated with cardiac lesions, especially of the coronary arteries; but the absence of physical signs do not always affect the diagnosis, as it frequently occurs that the lesions are only discovered after death. Pre sumptive signs which deserve atten tion:— The age of the patient; true angina is very rare before forty.
The pain commences always in the heart, while in pseudo-angina it is as cribed to the arm and radiates in several directions.
The infrequency of the attacks in true angina, the patient being liable to suc cumb in the second or third attack.
True angina is provoked by effort, emotion, and disorders of digestion.
It occurs in the day-time, while in false angina the attacks are generally nocturnal.
Patients suffering from true angina are pale and can neither stir nor breathe. In the false angina he is agitated, gets up from bed, and runs to the window for fresh air. Rendu (Med. Press and Cir cular, July 22, '96).
Diagnosis of angina pectoris due to disease of the coronary arteries, based upon retrosternal pain, with tendency to radiate; a sensation of anguish and. fear of imminent death; the tendency of the attack to be excited by exertion, by emotion, or by exposure to cold. The pain is similar to that experienced in a limb the main artery of which is, by atheroma, diminished in calibre. Owing to the defective supply of arterial blood. the heart contracts in a manner painful to the patient, the peripheraI nerve dis tributions wanting a due supply of oxy gen. P. Merklen (La Semaine Hied., Aug. 9, 1900).