Chest Spasm. Breast Pang.
It is supposed that this dangerous and most frightful difficulty is due to spasm of the nerves of circulation and motion due to over stimulation of the vasomotor center. It is not regarded as a disease of itself, but as a consequence of diseased conditions, especially but not necessarily of the heart. There is always contraction of the blood vessels and consequent crowding of blood in the left side of the heart, causing the cavities to become distended and unable to perfectly empty themselves.[1] Nitroglycerine is a vasodilator that is still used to treat angina.
Symptoms. — Angina pectoris, or "Chest Spasm," is spasmodic and neuralgic in character. A first attack comes on without warning, usually after exertion, especially after eating, or walking up hill or against the wind, or bicycle riding by elderly persons soon after eating; or an attack may be caused by sudden and intense emotion. There is intense pain near the heart and under the breast-bone. The agony experienced is excruciating and indescribable. A sensation of pressure and constricture about the chest is felt; a feeling of suffocation, although breathing is not really interfered with. Pain may shoot from the region of the heart in various directions, and possibly tingling and numbness of the fingers may follow. There are indications of general disturbance. The pulse, at first strong, soon becomes feeble, or irregular. The countenance assumes an anxious and distressed expression, and the patient realizes the liability of death. The face is pale and covered with perspiration — cold and bead-like — while the rest of the body is cold and dry. Very nervous persons may have chattering of the teeth, and fainting or convulsions may follow. An attack may itself be made up of several spasms. The difficulty ceases as suddenly as it commences; but it is always liable to recur under very little excitement or over-exertion. Death rarely follows the first attack. A short attack may last only five minutes and a very long one two or more hours.
Treatment. — Nitrate of Amyl, or nitro-glycerine[1] are often administered in very small doses, one or two drops of the former, or a single pellet of the latter. These give relief, but are not sanative agents. Five drop doses of equal parts of compound spirits of lavender and of third preparation of lobelia may be safely administered in frequent doses and will be found a valuable and efficient antispasmodic. In severe cases the same preparation in warm water may be used as an injection to the bowels. If the stomach is filled with indigestible food a quick emetic of salt water and mustard should be given[2]. The patient should be placed upright in an open place and his clothing about the neck, chest and waist loosened. Hot water to the feet and hot applications or stimulating liniment over the chest will be found advisable. Between attacks persons subject to them should live most carefully and avoid all excesses in diet, habits and emotions. They should carry with them the antispasmodic mentioned in order to ward off the first symptoms of an attack. Rheumatism, gout or heart disease, often the cause of angina pectoris, should be treated appropriately.
False, or Pseudo Angina Pectoris. — This is a disease with symptoms similar to the above, only modified[3]. It occurs chiefly in women, after a meal, in hysteria, or at the change of life. The absence of intense pain distinguishes it from true angina pectoris. Treatment should be similar in character, only milder. The false is never fatal, although the symptoms are very distressing. Angina pectoris seldom occurs in persons under forty-five years of age.
[2] People often mistake this discomfort for stomach problems, as vomiting can decrease discomfort. I couldn't find any contemporary evidence in favour of inducing emesis or stomach pumping as a treatment, however.
[3] Other sources at the time of the author suggest that the difference between "true" and "false", or "pseudo-", angina is the presence of lesions. These type of terms are uncommon now, as undiagnosed angina-like pain would be referred to as something like "left precordial chest pain" before a diagnosis was made.