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December 22, 1945

INSOMNIA DUE TO LEFT VENTRICULAR HEART FAILUREUNRECOGNIZED AS SUCH AND INADEQUATELY TREATED

JAMA. 1945;129(17):1158-1159. doi:10.1001/jama.1945.02860510024006

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Abstract

The signs and symptoms of left ventricular failure have been described frequently, and their clinical significance is well known. Certain symptoms, namely exertional dyspnea, paroxysmal nocturnal dyspnea, orthopnea and sometimes cough, and certain signs, namely gallop rhythm, pulsus alternans and increase of the pulmonary second sound, are generally recognized as early evidence of failure of the left side of the heart. Patients with dyspnea and orthopnea do not, as a rule, sleep well, but little space in the literature has been devoted to the insomnia resulting from these symptoms other than to mention that it occurs, for in most patients the insomnia is of secondary importance. Relief of pulmonary congestion by either digitalis or diuretics often causes a striking improvement in the patient's condition, and as the orthopnea disappears so does the accompanying insomnia.

There are patients, however, with left ventricular failure and pulmonary vascular congestion in whom the principal

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