March 20, 1897
While physicians and pathologists are well acquainted with the clinical and pathologic changes which take place in the heart in cases of true disease, we know very little about those alterations in its nervous and mechanical government which result very often in serious functional disturbances, and some of the most troublesome and puzzling cases which we have to treat occur in patients without apparent grave organic valvular or myocardial disease, but who nevertheless suffer from cardiac disorders with palpitation and a sense of oppression and precordial discomfort. Quite thirty years ago, attention was called to at least one type of this condition by Dr. J. M. Da Costa, who described it under the title of “The Irritable Heart of Soldiers,” but although we in this country have not a sufficiently large military force to bring us in contact with persons whose hearts have been strained by the severe exertions of military life, active practitioners constantly see persons who have over-exerted themselves in athletic games, presenting symptoms of cardiac disorder which follow out in every respect the symptoms described by Da Costa. In some of these cases any exertion develops very marked over-action of the heart so that it beats violently against the chest wall. Its sounds are exaggerated and its impulse is diffused. In other cases the action of the heart may become unduly feeble, yet the age of the patient, the condition of his blood vessels, showing an absence of degenerative changes, and the absence of any history of infectious disease, prevent us from considering that there is degenerative change in the heart muscle.
Cardiac Disturbances as the Result of Exhaustion. JAMA. 2014;311(12):1255. doi:10.1001/jama.2013.279411