Encyclopædia Britannica, Ninth Edition/Angina Pectoris

ANGINA PECTORIS, a term applied to a violent paroxysm of painful sensations in the chest, arising for the most part in connection with some form of heart disease. An attack of angina pectoris usually comes on with a sudden seizure of pain, felt at first over the region of the heart, but radiating through the chest in various directions, and frequently extending down the left arm. A feeling of constriction and of suffocation accompanies the pain, although there is seldom actual difficulty in breathing. When the attack comes on, as it often does, in the course of some bodily exertion, the sufferer is at once brought to rest, and during the continuance of the paroxysm experiences the most intense agony. The countenance becomes pale, the surface of the body cold, the pulse feeble, and death appears to be imminent, when suddenly the attack subsides, and complete relief is obtained. The duration of a paroxysm rarely exceeds two or three minutes, but it may last for a longer period. The attacks are apt to recur on slight exertion, and even in aggravated cases without any such exciting cause. Occasionally the first seizure proves fatal; but more commonly death takes place as the result of repeated attacks. Angina pectoris is generally held to be a neurosis, or nervous affection of the heart, but its causation is still a matter of uncertainty. It seems occasionally to manifest itself where no organic heart disease is discoverable, either in life or after death, but in the great majority of cases some morbid condition of the heart's structure is undoubtedly present. A diseased state of the coronary arteries, the nutrient blood-vessels of the heart, has been found in a large proportion of the cases, examined post mortem; but, on the other hand, these arteries may be found diseased where no paroxysm of angina had ever occurred; and further, it is well known that various other forms of heart disease may have angina pectoris associated with them as a prominent symptom. Angina pectoris is extremely rare under middle life, and is much more common in males than in females. It must always be regarded as a disorder of a very serious nature. In the treatment of the paroxysm much relief is obtained by opiates, and by the inhalation, under proper precautions, of anæsthetic vapours, such as ether, chloroform, and nitrite of amyl, To prevent the recurrence of the attacks, something may be done by scrupulous attention to the state of the general health, and by the avoidance of mental or physical strain, for it is certain that attacks in those who are the subjects of the disorder are often precipitated by errors in living, and by undue exertion or excitement.