CERTAIN CARDIAC REFLEX SYMPTOMS DUE TO DIS- 
TURBANCES OF REMOTE ORGANS? 
By A. G. SISON 
‘Of the Department of Medicine, College of Medicine and Surgery, 
University of the Philippines 
Palpitation, chest oppression, and precordial distress are some 
of the cardiac symptoms that the laity regards as the usual in- 
dications of cardiac disease. I may venture to say that physi- 
cians are not exempt from this belief and are often disposed 
toward diagnosticating a cardiac affection the moment a patient 
describes one or all three of the above symptoms. 
It is surprising to me how frequently the said symptoms are 
preceded by others that are physically just as troublesome and 
distressing, and yet those suffering from them do not consult 
a physician until the advent of the above-mentioned symptoms 
referable to the heart. The probable reason is that the laity 
is frequently under the impression that, in all likelihood, sudden 
death is the ordinary outcome in any affection in which the 
heart might be involved. They hear of many sudden deaths: 
that were attributed to cardiac failure, and doubtless in many 
instances rightly so; but it is no less true that there are very 
many individuals who are suffering from symptoms seemingly 
of cardiac origin, and yet the most careful examination and 
observation fail to indicate that this organ is at fault. On the 
contrary, the heart is normal, while the seat of the trouble is 
in some neighboring or remote organ or organs that may exert 
some influence on the heart in various ways—sometimes by 
nervous connection, at other times by mechanical influences or 
by the presence of certain toxic substances acting either on the 
nervous mechanism of the heart or directly on the heart itself, 
and in still other instances we have the intervention of a psychical 
factor to explain the appearance of the cardiac reflex symptoms. 
A person who has the slightest suspicion that his heart is 
diseased is often haunted by the fear of impending death. His — 
mind is focussed, as it were, entirely on his heart. He not only 
feels and counts his pulse, but watches for the slightest symp- 
*Read before the Manila Medical Society, December, 1916. 
. 409 
