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Updated: May 24, 2025
The acute symptoms being over, a careful analysis of the probable cause of the anginal attack should be made. If it is a general sclerosis, the treatment should be directed to that condition. If it is a myocarditis, a fatty degeneration of the heart or a fatty heart, this should be properly treated as previously described.
It could of course be taken only in those cases in which there were more or less continued anginal pains; the true typical acute angina pectoris attack is over, or the patient is dead, before any blood pressure determination could be made. When there is more or less constant ache or frequent slight attacks of pain, the blood pressure may be raised by the causative disease, arteriosclerosis.
Here there is a gradual failing of the heart muscle, with circulatory insufficiency, until the final heart pang occurs. Anginal attacks before the age of 40, presumed, from a possible narrowing of the aortic valve, to be due to coronary sclerosis, are frequently due to a long previous attack of syphilis.
Instances occasionally occur in which a patient had an anginal attack, as denoted by facial anxiety, paleness, holding of the breath, and a slow, weak pulse, without real pain. This has been called angina sine dolore. The patient has an appearanece of anxious expectation, as though he feared something terrible was about to happen.
But on account of the well-known dangers of this drug, it should only be administered by a medical man. To prevent recurrence of the attacks something may be done by scrupulous attention to the general health, and by the avoidance of mental and physical strain. But the most important preventive of all is "bed," of which fourteen days must be enforced on the least premonition of anginal pain.
Perhaps any one of these conditions may be a cause of the heart pang, and no one be the only cause. In a true angina, death is frequently instantaneous. In other instances, death occurs in a few minutes or a few hours; or the patient's life may be prolonged for days, with more or less constant chest pains and frequent anginal attacks.
In such patients cardiac tonics may be considered, but they must be used with great care. Digitalis may be needed, but it should be tried in small doses. It often makes a heart with arteriosclerosis have severe anginal attacks.
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