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Etymologically tachycardia means rapid heart. There are two forms of
rapid heart, that which is constant and that which occurs in
periodical attacks. It is for this latter that the term tachycardia
has been more particularly used, though occasionally the adjective
paroxysmal is attached to it to indicate the intermittent character of
the affection. With regard to the persistent type of rapid heart
something deserves to be said, however, because patients' minds are
often seriously disturbed by them. Often it has existed for years,
sometimes is known to be a family trait and probably has existed from
childhood, yet the discovery of it may be delayed until some
pathological condition develops, calling for the attendance of a
physician who may be needlessly alarmed and in turn alarm his patient
by his recognition of it. The cause for this persistent rapid pulse is
not well known and is difficult to determine. Heredity, as has been
suggested, sometimes plays an important role in it. Certain families
have one or more members in each generation with rapid hearts.
Whenever persistent rapid heart is a family trait the patient can be
assured, as a rule, without hesitation, that the general prognosis of
the case is that of the lives of the rest of the family. Usually the
symptom seems to mean nothing as regards early mortality or any
special tendency to morbidity.

Favorable Prognosis.--While a rapid pulse often and indeed usually has
some serious significance, it must not be forgotten that it may be an
individual peculiarity and be quite compatible with long life and hard
work. One of the first patients that I saw as a physician had a pulse
between ninety-six and one hundred. As there was a slight tendency to
irregular heart action also, I was inclined to think that there must
be some cardiac muscle trouble. There was apparently no valve lesion.
He told me that a physician ten years before had noted his rapid pulse
and had made many inquiries about it which rather seriously disturbed
him. He had been an extremely healthy man during his fifty-five years
of life and there seemed no reason to conclude, since his rapid pulse
had been in existence for ten years, that it meant anything serious.
He has now lived well beyond the age of seventy and still has a pulse
always above ninety. Contrary to what might be thought, he is an
extremely placid, unexcitable individual, who, under ordinary
circumstances, will probably live for many years to come. He has no
family history of tachycardia, though there is a history of rather
nervous irritable hearts in other members for two generations.

An interesting case of this kind came under my observation about
fifteen years ago in a clergyman whose pulse was never below ninety,
and who on slight excitement, or after a rapid walk, or after a heavy
meal, would have a pulse of 120. He knew that it was a family trait,
his father having had it yet living to be past seventy. He gave a
history of its having been recognized in his own person more than
twenty years before. His general health, however, was excellent. He
took long walks and, indeed, pedestrian excursions were his
favorite exercise. He was able to go up flights of stairs rather
rapidly without discomfort. He was the pastor in a tenement house
district so he had plenty of opportunity for such exertion. Infections
of any kind, colds and the like, disturbed his pulse very much, if the
ordinary standard was taken, but it was not irregular and the increase
in rapidity was probably only proportionate to the original height of
the pulse in his case. After all, as the normal pulse of sixty to
seventy rises to between ninety and one hundred even in a slight
fever, it is not surprising if a pulse normally above ninety should
rise fifty per cent. to one hundred and thirty-five under similar
conditions. He is now well past sixty, after over thirty-five known
years--and probably longer--of a pulse above ninety, yet he is in
excellent general health and promises, barring accident, to live
beyond seventy.

Some ten years ago I first saw another of these cases of fast heart,
with a family history of the affection in a preceding generation. He
was a man who had not taken good care of himself and had been
especially over-indulgent in alcohol. This indulgence consisted not in
rare sprees but in the persistent daily taking of large quantities of
straight whiskey. In spite of warnings, he has not given up this
habit; yet at the age of sixty-five he is apparently in good health
and is able to fulfill the duties of a rather exacting occupation.

Persistent rapid pulse often occurs in connection with some
disturbance of the thyroid gland. The larval forms of Graves' disease
occur particularly in young persons, though they are sometimes seen in
those beyond middle life. They seem to be due to a lack of development
of the thyroid in consonance with the rest of the tissues, though
occasionally, especially after the menopause, they seem to be
connected with some degenerative process out of harmony for the moment
with other forms of degeneration. When they occur in young persons
they may, of course, represent the beginning of incipient Graves'
disease, but they are often only functional and the symptoms may pass
away entirely. The rapid heart action may come and go, though usually
the attacks last for some days and oftener for a week or more at a

Paroxysmal Tachycardia.--A rapid heart may not only exist continuously
in an individual for many years without any impairment of general
health or shortening of life, but there may be spasmodic attacks of
this condition with the pulse running up so high as to deserve the
name of paroxysmal tachycardia; yet the patient may live for many
years and die from some affection not connected with his heart.
Perhaps the most remarkable case of this kind on record is that
reported by Prof. H. C. Wood of Philadelphia. The patient was a
physician in his later eighties when he came under Dr. Wood's
observation. His first attack of paroxysmal tachycardia came in his
thirty-seventh year. These attacks had apparently always been similar
to those he then suffered and were abrupt in onset and the pulse would
rise rapidly to 200 a minute. The original prognosis had been, of
course, very unfavorable. The physician had outlived all the prophets
of evil in his case, however. When large numbers of these cases were
studied, it was found that they always last more than ten years, and,
while heart failure in such cases is reported, it is doubtful if this
occurs with more frequency in these patients as the result of strong
reflexes than in the general run of patients, for it must not be
forgotten that there is a certain average number of deaths from
so-called heart failure in people supposed to be in good health.

In connection with these attacks of paroxysmal tachycardia, there
often come intense feelings of depression and even local disturbances
of circulation. It is probable that in many cases there is a serious
factor at work. MacKenzie has suggested that they are due to nodal
rhythm of the heart in which the heart beat does not start at the root
of the sinus as is usual, but in some other portion of the musculature
and as a consequence there is serious interference with the regular
rhythmic action. In a number of cases of heart failure, tachycardia
becomes a prominent feature and it is probably due to some such
disturbance as this. Such cases often look very serious for a time,
yet frequently recover completely after a brief interval. This must
not disguise the fact, however, that many of these cases, especially
where acute dilatation of the heart can be demonstrated, are extremely
dangerous and may end in a sudden fatal termination. The patient seems
so much prostrated that occasionally the physician may doubt whether
it is worth while to put him to the bother necessary in order to
diagnose the acute dilatation of the heart. It always is, however. If
it were nothing else but the occupation of the patient's attention
with the doctor's manipulations, as far as that is possible, the
effect would be good, besides whatever irritation may be caused to the
heart muscle itself by percussion of the heart area will probably do
mechanical good.

The most important element evidently is that the patient shall not be
allowed to lose courage or to think that nothing can be done for him.
Something must be done, and a combination of swallowing movements and
deep breathing, as far as that is possible, with counter-irritation
through the chest wall should be carried out. Drugs also should be
employed and the aroma of strong coffee with the irritating effect of
ammonia upon the nostrils should be employed. These act upon the vagus
so as to stimulate the heart, but above all they act upon the mind,
and nothing so stimulates the heart as reawakened hope.

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