Definition.—Palpitation is the consciousness of the heart's action, which may be normal in power and in time of beat, though there is increased power and frequency, attended by more or less anxiety and distress.

Etiology.—The fact that "delirium cordis," a condition of extreme disturbance, frequently exists in heart-troubles, and yet the patient is entirely unconscious of the existence of any disturbance, while at other times the patient complains of great distress from the severe palpitation when an examination reveals the heart's action to be normal in power and frequency, shows conclusively that it may be nervous in character.

Among the causes that may be mentioned as giving rise to palpitation, are:

Dyspepsia.—Indigestion, I believe, is responsible for more cases of functional heart-disease than all other causes combined. The distention of the stomach by gas, presses against the sensitive nerves of the heart, which gives rise, not only to palpitation, but irregular heart action as well.

Nervous Lesions.—Emotional excitement, especially the distressing emotions, such as fear, grief, and despondency, are causes;

It also occurs in neurasthenia. Hysteria is not infrequently accompanied by palpitation. Sexual excess, especially masturbation, is another common cause of cardiac palpitation.

Stimulants.—The use or abuse of tea and coffee, as well as alcohol, will cause an irritable and excessive action. Tobacco may be included in the same list. The irritant action from a poorly elaborated blood, as found in anemia, will also give rise to this condition; prolonged fever gives rise to palpitation in the same way.

Reflexes.—A common, though often overlooked, source of irritation is rectal troubles. Hemorrhoids, fissures, fistules. and papillae may give rise to such nerve-waste as to produce their reflex influence on the heart. Disease of the uterus, ovaries, and urethra may act as indirect factors in the same way. Chronic valvular lesions, as well as some other organic lesions, may give rise to palpitation, though not frequently.

Symptoms.—If the attack be mild in character, there may be but little change in the character of the pulse, the force and frequency being found, upon examination, to be normal. The consciousness of the patient, of his heart's action, however, renders him nervous, and a worried or anxious look tells of his mental discomfort.

Where the attack is severe, the heart beats tumultously, and the patient feels the impulse against the chest-walls, and often hears the sound of his own heart-beat, while the physician may see the pulsation if the chest-walls be thin, and, by placing the hand over the heart, detect its throbbing character. There may be a choking or smothering sensation, especially if the subject be hysterical, and the patient, alarmed and anxious, fears impending dissolution.

Sometimes a cold sweat occurs; there is pain in the precordial region, rapid breathing, the extremities become cold, the eyeballs protude, there is a ringing in the ears, vertigo, and an attack may terminate in unconsciousness. If the patient be neurasthenic, an attack may be followed by the passing of a copious quantity of clear urine.

The attacks are usually intermittent and paroxysmal in character, though they may be more or less constant.

Physical Signs.—Inspection will often reveal a visible and forceful impulse, and also throbbing of the superficial vessels.

By placing the fingers or the hand over the region of the heart, a heaving and throbbing impulse is felt, while the pulse at the wrist is full and bounding or sharp and frequent, sometimes quite irregular.

Auscultation shows the first sound magnified; it is loud, abrupt, short, and may be heard without applying the ear to the chest.

Percussion may reveal an increased dullness, though usually the dullness is natural.

Diagnosis.—The condition, palpitation, is readily recognized by the complaint of the patient, and the symptoms already named, and a careful physical examination will reveal whether it be a neurosis or due to organic disease.

Prognosis.—The prognosis is favorable as to life, and also as to permanent results, where the causes can be removed. When due, however, to epilepsy, prolonged masturbation, spinal irritation, and such causes as frequently do not yield to treatment, the outlook is not encouraging.

Treatment.—The patient's mental disturbance must be quieted by positive assurances that an unfavorable termination will not occur. It is well to put the patient to bed, enjoin quiet, and have anything that would tend to excite him removed from his presence.

After a hopeful and reassuring talk, place the patient on pulsatilla, if the sensation of impending death predominates, or if there be a constant dread of an indefinable character present; in these cases pulsatilla will give good results. Ten to twenty drops of the specific tincture in a half glass of water, a teaspoonful every one, two, or three hours, as the case may demand. If there be precordial oppression, with a sense of suffocation, add ten drops of specific lobelia to the above remedy, and give every twenty, thirty, or sixty minutes. If there be pain present, alternate the above with bryonia or macrotys, ten drops of each to water four ounces, and give teaspoonful every hour.

Where there is great excitement, the patient is flushed, nervous, and restless, gelsemium, ten to thirty drops to half a glass of water, will be of good service. Cactus is a good remedy when the heart's action is weak. When the force is violent, veratrum, thirty to sixty drops to half a glass of water, will be the better remedy.

After an attack is over, the treatment will be directed to overcoming the exciting cause.

When due to indigestion, the diet should be regulated, fluids at meal-times forbidden, and the various dyspeptic conditions corrected.

If anemia is the exciting cause, our attention is directed to furnishing a better quality and quantity of blood.

If alcohol, tea, coffee, or tobacco are responsible, they are to be absolutely prohibited. Where due to rectal irritation, or ovarian or uterine trouble, these wrongs must be corrected before a cure can be effected.

Regular habits should be enjoined, all forms of dissipation corrected, and for persons of sedentary habits an out-of-door life advised. A trip, lasting several weeks or months, where the attention of the patient is turned from self to new objects, new faces, new scenes, will often accomplish far more than will the administration of drugs.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.