TOBACCO, TEA, ETC. — Excess in to bacco (less often alcohol, tea, and coffee) and lead poisoning may occasion spurious angina, or again they may aggravate a genuine paroxysm depending on organic lesions.
While certain cases are evidently true angina and others equally obviously pseudo-angina, some are extremely puz zling.
Etiology. — Males over 40 years of age in comfortable worldly circumstances make up the majority of sufferers from angina pectoris. Predisposing causes are: alcohol, syphilis (arteriosclerosis, tabes dosalis), rheumatism, gout, diabetes, chronic nephritis, and influenza. Some times attacks are hereditary.
As exciting causes may be named : physical exertion, mental strain, pro found emotion, and digestive disturb ances. The attacks may come in the day-time, especially at first; but some of the worst occur at night; so that finally they may make the patient dread going to sleep.
Angina pectoris due in part to the attitude of writing in haste, in part to nervous overexcitement. The attitude hampers respiration, and by compressing the abdomen interferes with the move ment of the diaphragm; in addition. there is a kind of spasmodic contraction of the fingers which is communicated to the muscles of the forearm. arm. and chest. The action of the whole heart, and particularly of the right ventricle, is impeded, and this leads to some degree of venous stasis, which would provoke a spasm of the coronary vessels zimulat lug an attack of true angina. Musgrave (Semaine MCid.. Jan. 25, '99).
Angina pectoris and the menopause. Attacks of angina pectoris observed for t he first time at the menopause may be dependent upon the changes occurring this period, or they may accidentally begin at this time from other and 'Inas soeiated causes. In the former case the attacks may be purely neurasthenic or hysterical, or they may be of vasomotor origin (spasm of the coronary arteries), giving the picture of severe organic an gina pectoris. These two forms may, of course, be combined. Th. K. Geisler (Vrateh, Feb. 12, 1900).
While, in general, the vascular origin of angina pectoris cannot be denied, eases occur which undoubtedly are due to lesions of the aortic or coronary plexus, and the cases cited are thought to justify the belief that in syphilitic angina pectoris, in which a coronary stenocardia might be considered prob able, there exist changes in the aortic plexus and in the nerves of the heart.
'this alteration of aortic or cardiac plexus may be in the nature of a neu ritis, or may be due to changes in the vessels of the nerves. the functional effects of which would be equivalent to a lesion of the nerve proper. Such changes in the nerves or vasa nervormn are caused by a terminal obliterating codarteritis, pericellular infiltration, or embryonic gunnnata which irritate the vessels. These changes can, in the large majority of cases, be controlled by energetic specific treatment; hence the importance of early etiological diag nosis. U. Benenati (La Itiforma Medica, May 3, 5. 0. and 7, 19024 Pathology. It is exceptional for at tacks of true angina pectoris to be observed in persons presenting no evi dence of organic circulatory lesion. The commonest underlying conditions are sclerosis of the coronary arteries, degen eration of the myocardium, cardiac hy pertrophy, atheroma of the aorta, aneu rism of that vessel near its origin, and aortic regurgitation. There is, however, "hardly an affection of the walls or cavi ties of the heart, scarcely a morbid con dition of the arteries that nourish it or spring from it, with which the distress ing malady has not been observed to be associated." (Da Costa.) recent writers lay stress on oblitera tion of the lumen of the coronary arter ies as the essential basis of true angina pectoris, which obliteration may be oc casioned either by sclerosis of the vessels or by changes in the aorta at their origin. "So intimately associated is the true paroxysm with sclerotic conditions of the coronary arteries that it is extremely rare apart from them." (Oster.) (Same view. Whittaker.) Case of angina pectoris without lesions of the coronaries in which death oc curred during a paroxysm. Aortic and mitral endocarditis was found post mortem, but no lesion whatever of the coronaries. Numerous personal autop sies on the bodies of old people, at the Bicare Hospital, where there had been no complaint of angina during life, and vet the coronaries were found to be al most occluded by atheromatous plaques. Pilliet confirmed these observations. He had found a large number of obstructed coronary arteries which had never caused angina. Auscher (Bull. de la Soe. Anat., Oct. 9, '91.