Nervous palpitation is an increased action of the heart without any detectable organic lesion of that organ. The heart’s activity is accelerated by irritation of the ganglia which we find imbedded in its substance, by irritation of the cardiac branches of the ganglion stellatum, which take their origin from fibres of the cervical portion of the sympathetic, by irritation of the nerve fibres which originate in the medulla oblongata, run down the spinal cord, pass out from the cord with the spinal nerves and become entwined with the sympathetic, and by irritation of the sympathetic in general, causing a contraction of the vessels, and thereby an increased blood pressure in the aortic system with consequent increased labor of the heart. These are the exitor nerves of the heart’s activity, its restraining or inhibitory forces rest in the pneumogastric and its ramifications. An irritation of the vagus slackens the movements of the heart in frequency, but a division of the vagi increases this frequency for the reason that then the exitor nerves have no restraining power to overcome. The blood too as regards its quantity, as well as its quality, has a powerful influence on the action of the heart.
The special causes of palpitation are: mental excitements of all kinds, such as fear, joy, anger and the like, diseases of the brain and spinal cord of various kinds, amongst them: hyperemia and inflammation of these organs, psychoses, hypochondria, hysteria, exhaustion from protracted night-watching, or venereal and other excesses, diseases of the abdominal cavity, such as accumulation of gas in the intestines, worms, gall-stones, renal calculi and affections of the genital apparatus, partial hyperasmia from suppressed menstrual or hemorrhoidal flow, chlorosis and anaemia, the first stages of consumption, gout and different drugs, especially alcohol, coffee, tea and tobacco.
Nervous palpitation of the heart is at times attended with dyspnoea, distress and even pain in the chest, with throbbing of the carotids, flushing of the face, or (oftener) with pallor and cold sweat, with dizziness, faintness, and specks or flashes of light before the eyes. Some persons cannot lie down, must sit up, or cannot lie on the left side. Auscultation often reveals the first sound increased and of a metallic quality, “the second sound is wanting only in cases of tremendous acceleration of the heart’s movements, where the heart has not had time fully to complete its diastole.” (Schroeter.)
After the attack the absence of murmurs, or of enlargement of the heart, establishes its diagnosis. The presence of a diastolic murmur excludes the diagnosis of a simple nervous palpitation, because such murmurs never occur without organic changes in the heart.
Its Prognosis depends entirely on the nature of the underlying cause. If that is removable, its effect will cease. In old people with atheroma of the arteries, it may end with apoplexy.
THERAPEUTIC HINTS
Acon., in young subjects, after fright, after wine.
Arsen., after suppressed herpes circinatus and suppressed perspiration of the feet.
Aurum mur., palpitation, sleeplessness, depression of spirits, with thoughts of suicide, constipation. Motion, wine or beer have no influence.
Asaf., in women, after suppressed discharges, or bodily exertions, with small pulse, breathing not oppressed.
Bellad., with congestion of the head.
Benz. ac, worse at night and when lying, alternating with tearing rheumatic pains in the extremities.
Cact grand., palpitation is preceded by rumbling in the stomach, pains in shoulders and arms, change of life.
Calcarea carb., after suppressed eruptions and pimples on the face, onanism. Cold lower extremities, vertigo on going up stairs, or up a hill, bloating in the pit of the stomach, craving for boiled eggs, copious menstruation.
Camphora, when attended with coldness of the skin, cold extremities, pale face , and sudden oppression of breathing.
China, great weakness from loss of vital fluids, long-continued nursing.
Coccul., tremulous palpitation from quick motion and mental excitement, with dizziness and faintness.
Coffea, after excessive exaltation, joy, surprise.
Digit, attended with apnoea, danger of suffocation, yellow aud blue face, worse from motion, from moving the arms.
Ferrum, ansemia, throbbing in all the blood-vessels, soft bellows sound at the apex, with anxiety in chest and heat rising from pit of stomach, with fear, after bodily exercise, also must move about, can neither sit nor stand.
Graphites., amenorrhoea, pimples on the face about the menstrual period.
Kali carb., throat feels as if squeezed, as if the lungs came in the throat , stitch pain and anxiety in pit of stomach and through the chest, pale grayish color of the face, dizziness in walking, cold feet, scanty menses.
Merc, sol., wakes with nervous trembling, thumping of the heart and agitation as if he had been frightened , weakness at the heart, as if dying.
Moschus, when combined with hysterical symptoms.
Nux moschata, paroxysms after midnight, as if the heart were stopping, and then beating violently, with loud belching, better from drinking hot water and keeping warm , must walk about. Hysteria.
Nux vom., after coffee, wine, liquors, spices.
Natr. mur., fluttering, long-standing chlorosis, with torpid skin and suppressed menses.
Nitr. ac, when caused by the slightest mental excitement.
Opium, after alarming events, causing fright, grief, sorrow, etc.
Phosphorus., dyspnoea, tightness across the chest, great weakness, and after any little mental excitement, violent hammering in the chest, aggravated by motion, benumbing all over.
Phosphorus ac, in children and young persons who grow too fast, after self-abuse, long grieving.’
Pulsat., young girls during the time of puberty , from suppressed menses.
Rhus tox., always worse when being quiet.
Secale, with profuse menstruation of a watery discharge, after sexual excesses, comes in paroxysms with spasmodic shocks from right side of chest into right arm and leg, coldness and numbness of right hand and stinging in fourth and fifth fingers, worse at night, after each meal, better in open air.
Sepia, tremulous, intermitting pulsation, suppressed menstruation.
Silica, always after quick or violent motions, such as playing ball, etc., panaritia.
Thea, after exciting talk and mental exertions, with sleeplessness.
Veratrum alb., headache, nausea, vomiting, diarrhoea, bleeding of the nose occasionally, cold perspiration on forehead.
Excerpted from: Special Pathology and Diagnostics with Therapeutic Hints – C.G.Raue, MD (1882)
