i7, i Sison: Cardiac Reflex Symptoms 411 
The organs that might be affected and give rise to cardiac 
reflex symptoms are the gastrointestinal, the liver, and the geni- 
talia. The probable relation between the latter and the heart 
is exclusively psychic in character. 
The cardiac symptoms observed in diseases of the digestive 
organs (namely, of the gastrointestinal and the liver) must 
not be hastily taken as such without previous consideration of 
the possibility that the latter organs may be frequently affected 
as the result of a primary cardiac affection. 
Another fact that is well established and that has been known 
for a long time is that dyspeptic conditions produce disturb- 
ances of the heart, especially in children. 2 The disturbance some- 
times consists in acceleration, but much more frequently in re- 
tardation and irregularity of the rhythm. Similar manifesta- 
tion is observed in adults, in whom, however, palpitation with 
tachycardia is much more frequent than bradycardia and some- 
times irregularity of rhythm. These symptoms are often as- 
sociated with anomalies of digestion, constipation, flatulence, 
eructations, and distention. 
Although the primary causes of these disturbances are found 
in diseases of the stomach, intestines, and liver, there is no 
doubt that they are not due to any lesion in the abdomen, for 
a variety of conditions may give rise to the same sequence in 
the heart; on the other hand, the same cause by no means pro- 
duces symptoms of equal severity in the same individual, or 
even in different ones. This makes it evident that the trouble 
lies in alterations in the central nervous system or in the intrin- 
sic nerves of the heart itself or in both ; at all events, nervousness 
is a very important factor in the development of these conditions. 
Potain, as quoted by Krehl, 3 has stated that the abdominal 
diseases giving rise to cardiac disturbances are not grave in 
character, and Krehl entirely agrees with him. Potain further 
says that the milder affections of the gastrointestinal tract and 
of the liver are the ones that are apt to be associated with car- 
diac reflex symptoms. He mentions that in certain cases there 
is even absence of dyspeptic processes, and the mere ingestion 
of certain foods, entirely harmless in other individuals, is fol- 
lowed by the above-mentioned cardiac symptoms. He is inclined 
to believe in some chronic irritation of the peripheral nerves and 
the existence of an extreme anomaly of the nerves, either in the 
central nervous system or in the heart. 
5 Krehl, Diseases of the Heart in Nothnagel’s Encyclopedia of Practical 
Medicine, 789. 
8 Loc. cit. 
