Changes in the Peripheral Circulation Accompanying “Tobacco Angina.”

Abstract

It is now fairly well established that coronary artery disease, occlusion, and consequent myocardial infarction constitute one of the pathological conditions associated with the syndrome, angina pectoris. There is, however, great diversity of opinion as to the mechanism of this symptom-complex; the probability is that typical angina pectoris is due to a single mechanism. There are several well recognized exciting causes of angina; such as physical effort, emotional excitement, exposure to cold or to fresh air, overeating, and in some patients tobacco smoking. We had observed a very few patients, beyond middle age, predisposed to angina pectoris, in whom the attacks could be provoked very promptly by smoking a cigarette. The attacks of pain induced by smoking were relieved by administering a nitroglycerin tablet dry under the tongue, but were not relieved by a tablet similar in appearance but not containing any nitroglycerin. The relief of pain was, therefore, not due to a psychic factor; no attempt was made to substitute any form of smoke other than that of tobacco. These few patients, therefore, offered an opportunity to study the peripheral circulation before, during, and after an attack of angina pectoris. This was done by making observations of any change in limb volume by means of a plethysmograph on the left arm, and simultaneously of the systolic and diastolic blood pressures in the other arm by the ausculatory method.