Effects of the Injection of Epinephrin in Soldiers With "Irritable Heart"

Abstract

of the skin. Five per cent, sterile boric acid ointment is a good dressing covered by sterile gauze pad and bandage, or 10 per cent, sodium bicarbonate ointment.The eyes are washed with solution of boric acid and covered, and the lids protected for some time with bland yellow mercuric oxid ointment and fear of further injury dispelled. Later dusting powder of bismuth and zinc oxid, or of zinc stearate will prove satisfactory for abraded skin areas.Dugouts and holes where a person is likely to sit are to be suspected and carefully evacuated by an attendant wearing oil canvas protection. Then chlorinated lime is scattered in places suspected. Articles of salvage and waste should always be held under suspicion of being contaminated. The clothing is soaked in several changes of water at 70 C. Instead of . strong alkaline remedies, potassium permanganate, 0.05 per cent, solution, is recommended, or a 0.1 per cent, zinc chlorid, and between the fingers or folds of the , scrotum, a weak silver nitrate solution. In advanced respiratory cases, oxygen inhalations are used.Owing to the censorship, the photographic reproduction of many interesting cases is not permissible. These cases should be given careful attention, and after treatment one need not necessarily excuse patients with mild skin burns from duty.

Familial Orthostatic Tachycardia Due to Norepinephrine Transporter Deficiency

“… Hyperadrenergic orthostatic hypotension18 Orthostatic tachycardia syndrome19,20 Postural orthostatic tachycardia syndrome16 Postural tachycardia syndrome16,52 Hyperadrenergic postural hypotension29 Sympathotonic orthostatic hypotension53 Hyperdynamic β‐adrenergic state17 Idiopathic hypovolemia12 Orthostatic tachycardia plus54 Sympathicotonic orthostatic hypotension10 Mitral valve prolapse syndrome55–57 Soldier's heart58 Vasoregulatory asthenia10 Neurocirculatory asthenia10 Irritable heart59 Orthostatic anemia9 Chronic fatigue syndrome60 …”

Floppy mitral valve/mitral valve prolapse syndrome: Beta-adrenergic receptor polymorphism may contribute to the pathogenesis of symptoms

“…If one accepts the hypothesis that some of the patients with the FMV/MVP syndrome were previously considered to have an irritable heart, soldier's heart, or neurocirculatory asthenia, then physicians have attempted to provide an explanation for these symptoms for more than a century [15][16][17]. In all these earlier observations, metabolic abnormalities, autonomic dysfunction, and hyperresponse to adrenergic stimulation were considered as a possible explanation for the symptoms of the FMV/MVP syndrome.…”

“…Fraser and Wilson [17], working in the Heart Section at a military hospital in England during World War I, demonstrated that very small doses of intravenous adrenaline produced a greater heart rate and blood pressure response in soldiers with an ''irritable heart'' compared to control subjects; they concluded that the sympathetic nervous system was unstable in the irritable heart soldiers. Peabody and his colleagues [16] at the United States Army Hospital, New Jersey, studied the effect of intramuscular injections of epinephrine in soldiers with irritable heart and compared the results to a control group; they also demonstrated a hyperresponse to epinephrine and concluded that ''it is distinctly interesting therefore that so large a proportion should be hypersensitive to epinephrine, and one should at least consider carefully whether an unusually excitable sympathetic nervous system may play a part in determining their condition.'' Boudoulas et al [10] demonstrated that symptomatic patients with the FMV/MVP syndrome, mostly females, with high adrenergic tone at rest had hypersensitivity to isoproterenol administration as manifested by dose-related reproduction of symptoms and greater heart rate response compared to control subjects.…”

“…Neuroendocrine-cardiovascular or autonomic nervous system functional abnormalities have been postulated as an explanation for the symptoms in this group of patients, which is classified as the FMV/MVP syndrome [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Many clinical observations during the past 140 years suggested that individuals with irritable heart, soldier's heart, and neurocirculatory asthenia, most likely related to FMV/MVP syndrome, had a disorder of the sympathetic nervous system as a basis for their symptoms [15][16][17]. Previous studies from our laboratory demonstrated that patients with the FMV/MVP syndrome, mostly females, had a high adrenergic tone at rest and a hyperresponse to adrenergic stimulation [9,10].…”

Psychocardiac disorders.

“…For example, physiologic studies conducted on soldiers with neurocirculatory asthenia during World War I showed adrenergic hyperreactivity to the startle response (Peabody, Clough, Sturgis, Wearn, & Tomkins, 1918). Nine decades later, we are ignorant of the genetic and experiential precursors of the neurochemical perturbations eliciting this overreaction, even at a time when the entire human genome is known!…”