Muscular cramp, in relation with the phenomena of angina pectoris and 'intermittent claudication of the extremities' / by F. Parkes Weber.

  • Weber, Frederick Parkes, 1863-1962.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Muscular cramp, in relation with the phenomena of angina pectoris and 'intermittent claudication of the extremities' / by F. Parkes Weber. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    If, as seems probable, angina pectoris is really a claudication interrait- tente of the cardiac muscle, due to coronary ischsemia, then, as in the extremities, cramps will not be a necessary feature; and, indeed, the pulse almost precludes the idea that ordinary angina pectoris is a cramp of the heart-muscle. It will then be asked: When the main arteries are stenosed, why should not cramps be likely to occur in the heart as in the extremities? It probably does occur1 at times, and is expressed by syncope, which3 may be the fatal termination in angina pectoris.8 According to this view one may discard the cramp or spasm theory of angina pectoris, whilst still retaining the intermittent claudi- cation theory, regarding the latter term as synonymous with the coronary theory, and as affording the explanation of the phenomena of true angina pectoris; when it is accompanied by syncope, then, and then only, can cramp of the heart be considered as playing any part in the ensemble of an attack of angina pectoris. I will only add a few words, and these are regarding the coronary theory of true angina pectoris, which I have almost taken for granted in the foregoing words, but which seems to be as yet not universally accepted. A chief objection to the coronary theory is that stenosis of a coronary artery may be found post-mortem in individuals who have never been known to suffer from angina pectoris. This has been ac- counted for by anastomoses in the coronary circulation (see those pointed' out by Dr. Samuel West, Lancet, 1883, vol. i. p. 945, and others). The alleged cases of true angina pectoris without organic disease4 of the coronary arteries form a second objection to the coro- 1 A cessation of the heart's action in systole (or spasm) is probably the most frequent form of cardiac syncope. » This is the real justification for the name syncope anginosa, suggested by Parry. Parry wrote: I think it evidently appears that the angina pectoris is a mere case of syncope, or feinting, differing from the common syncope only in being preceded by an unusual degree of anxiety or pain in the region of the heart, etc. See Parry, op. cit., p. 67. 3 If angina pectoris were a cramp of the heart the pain or anguish felt during the attack might be explained by supposing the nerve-endings to be stimulated by the contraction of the heart-muscle ; which explanation would make the sensory phenomena of angina pectoris analogous to the pain felt during cramp in the calf of the leg. If, however, as I maintain, angina pectoris be not necessarily associated with cramp of the heart, another explanation must be adopted, such as that the pain is directly dependent on ansemia of the myocardium (Cf. Huchard, op. cit, pp. 618 and 619). This would make it analogous to the pains long ago recognized (see Percivall Pott, Chirurgical Works, 1775, p. 794) as premonitory signs in senile gangrene; the accumulation of waste products may likewise have something to do with its production, as in the production of the more chronic pains or stiffness in the limbs after violent exertion. 1 On this question some of the earlier recorded necropsies are particularly interesting. In the first necropsy on a case of angina pectoris, recorded by Heberden, nothing to account for death was found. A gentleman had apparently heard of Heberden's description of angina pec- toris, and considered that the symptoms corresponded with his own. Accordingly, on April 16,1772 (see Med. Trans. Coll. Phys., London, 1785, vol. iii. p. 1), Dr. Heberden received a letter, signed Unknown, from the gentleman describing his symptoms, and saying that he had left directions that, after his death, Dr. Heberden should have an opportunity of dissecting his body to find out the cause of the disease. The gentleman died suddenly within three weeks afterward, and Heberden obtained the services of Mr. John Ihimer to make the examination, but no pathological change likely to cause death was discovered. Jenner (see Jcnner's letter to Parry, in Parry, op. cit., p. 3), however, thought that in this case the coronary arteries were