The practice of osteopathy

There are several forms of irregular heart action. For a description of same it is probably best to refer the student to special works.[103]

The more common forms are Sinus Irregularities, the Extrasystole, Paroxysmal Tachycardia, Auricular Fibrillation, Auricular Flutter, and Heart-block. Pulsus Alternans is a rare form, and is of grave significance when the heart muscle is degenerated. A knowledge of auricular fibrillation is of special value, for it is a common form and often indicates a serious condition.

Most of the irregularities are not of special pathological importance, providing the heart muscle is healthy. They are best studied through instrumental means and require considerable experience in order to determine the exact condition.

Frequently, unnecessary worry has been the result in discovering irregularities in the young as well as in otherwise healthy adults. Only when the cardiac muscle is diseased or degenerated through various infections and toxic properties in the blood should they receive unusual attention.

Dorsal and lower cervical lesions that affect the heart by way of the sympathetics no doubt disturb nutrition of the heart tissues. And lesions of the vagi, particularly of the upper three cervicals, will disturb the rhythm, rate, strength, and conductivity of the impulse through auricles and ventricles. In no other organ of the body will the osteopath be better rewarded for careful and painstaking work than in normalizing the stimuli from sympathetic and vagi that influence the heart. Stimulatory and inhibitory efforts will frequently suffice, but in our judgment it is always better to secure interosseous adjustment if possible.

Though a number of individuals with heart irregularities are of a neurotic type, that predisposes to nervous disturbances of various kinds, still it would be an interesting study, especially in cases of children, to note what percentage are the result of upper cervical lesions caused by birth injury.

Angina Pectoris

Angina pectoris is characterized by pain in the cardiac region which usually extends to the inner side of the upper arm and forearm. “This region corresponds to the peripheral distribution of the lower cervical nerves (6th and 7th in the arm) and the upper three or four dorsal nerves (in the upper arm and the chest).”[104] Occasionally similar areas of the right side are affected, and in a few there is pain in the lower jaw and back of the ears. “The starting of the pain is usually across the chest, about the level of the third ribs, or as low as the fifth ribs,” although the inception may be anywhere in the left chest or the arm. The duration of the pain is from a few seconds to several minutes; sometimes it may remain for several hours.

Osteopathic lesions are invariably found in the upper dorsal, including ribs, or lower cervical region, which are predisposing factors that tend to exhaust and weaken the cardiac muscle, and disturb the coronary circulation, so that resistance is lowered. Thus toxic agents and infections may readily involve the cardiac tissues. Many cases present more or less arteriosclerosis, which involves the heart and affects its circulation. Inflammation of the root of the aorta from syphilis is a frequent cause. Valvular heart disease and chronic nephritis are other underlying factors. Worry, strenuous living, and continued physical strain are to be considered. There are a group of cases, that are comparatively mild and frequently found in women, that are of toxic origin, due to intestinal stasis as a result of constipation, adhesions, etc. The ileo-cecal section is commonly involved in these instances. Focal infections may be an exciting cause.

The osteopathic lesions undoubtedly affect the cardiac innervation, particularly vasomotor and trophic, thus leading to consequent disturbances of cardiac circulation and resulting irritation to the ganglia. Sclerosis and spasm of the coronaries, ischemia, cramping, exhaustion, and degeneration of the heart muscle, and cardiac neuralgia, are various results that may take place.

The paroxysm usually begins suddenly, often during exertion or intense mental emotion. The pain is agonizing and of a grip-like character, and there is a feeling of impending death. The intercostal muscles are constricted and there may be a feeling of suffocation. The pains radiate up the neck and down the arm, and may be accompanied by numbness or tingling. There is usually extreme pallor, and the skin is ashen. Sweating is not uncommon, and dyspnea may be present. The attacks occur at intervals, varying from a few days to many years. After the paroxysms there is instant relief.

Other cases may present less severe attacks.

In the diagnosis the only condition with which true angina pectoris is liable to be confounded is pseudo-angina pectoris. Pseudo-angina or hysterical angina occurs chiefly in women or in neurasthenic men. These cases are often excited by toxemia. The attack usually occurs at night and is unassociated with organic heart disease. There is a feeling of cardiac distention instead of constriction as in true angina. There is emotional excitement and the attack lasts one or two hours, which is usually longer than that of true angina. The prognosis is unfavorable, although many cases live for a number of years. A few cases have recovered under a thorough course of treatment.

The treatment of angina pectoris consists in correcting the disordered upper dorsal vertebræ, the upper left ribs over the heart, and the lower cervicals. Invariably lesions are found in this region and if the treatment is applied to correct these disorders, the attack can frequently be relieved. By following up the treatment during the intervals, a number of cases can be practically cured. A common lesion found is a slight lateral curvature in the upper dorsal region. This curvature is oftentimes great enough to cause a subdislocation of several of the ribs, which certainly complicates the derangement, at least as far as a quick cure is concerned.

During the attack raise the ribs over the heart at the point of constriction so as to relieve the impinged nerve fibers. Hot drinks are of value. The vagi and phrenic nerves may also be at fault in some cases. The sensory nerves to the heart are from the first, second and third dorsals.

Ice-bags or heat applied locally will be a helpful measure. In cases where there is high arterial tension, an inhibitory treatment to the upper and middle cervical regions will be of special aid, as it relieves this tension by affecting the vasomotor nerves. This treatment will at least overcome the vasomotor form of angina pectoris. Hot foot-baths and friction will also be found of value. In many cases under forty or forty-five syphilis is a cause. In cases past middle life there is often organic disease of the circulatory organs.

The patient should at all times avoid any excitement and live a very quiet life. He should take frequent vacations. He should take the best of care of himself and his food should be nutritious. In pseudo-angina the treatment is to relieve the irritation to the nerves affected as well as the underlying affection.