ROBERT D. TAYLOR, M.D.
ROBERT BIRCHALL, M.D.
Acute left ventricular failure, characterized by an agonizing struggle for air, is terrifying to the patient, family, and physician. The seizure is distinctive, therefore most contemporary descriptions are similar. Probably the first account of this syndrome was that of Aretaeus of Cappadocia.1 His words paint a picture that has been little improved upon in the 2000 years since his death. In patients with paroxysmal nocturnal dyspnea, “the cheeks are ruddy; eyes protuberant, as if from strangulation; . . . voice liquid and without resonance; a desire of much and of cold air; they breathe standing, as if desiring to draw in all the air which they possibly can inhale; and, in their want of air, they also open the mouth as if thus to enjoy the more of it; pale in the countenance, except for the cheeks, which are ruddy; sweat about the forhead and clavicles; cough incessant and laborious; expectoration small, thin, and cold, resembling the efflorescence of foam; neck swells with the inflation of the breath; the praecordia retracted; pulse small, dense, compressed; and if these symptoms increase, they sometimes produce suffocation, after the form of epilepsy.”
Following in the footsteps of Aretaeus, many students of heart disease (White,2 Weiss,3 Ernstene,4 Blumgardt,5 Smith,6 Robb,3 Wolferth,7 Harrison,8 Prinzmetal,9 Christie,10 Hope11) have written of the mechanism and treatment of this syndrome in recent years.
The large number of reports belies the relative infrequency of this state, but, on the other hand, emphasizes its impressive nature. With the exception of. . .