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DACOSTA DESCRIBED "IRRITABLE HEART" in 1871,1 a peculiar form of functional disorder of the heart seen in the military population during the War Between the States. He thought this disorder was similar to that described earlier among British troops in India and in the Crimean War. The disorder frequently presented either after an episode of diarrhea and persisted after the digestive disturbances had passed away, or originated suddenly without previous digestive disorder. Two-thirds of his 300 patients were 16 to 25 years old. These cases represented the most common cardiac malady he encountered among soldiers; he also recognized that the disorder existed in the civilian population as well. Symptoms included palpitation of varying severity and frequency, with attacks lasting for several hours, attended by increased pain in the cardiac region, accompanied by a great deal of distress. "The 'seizures' were . . . most readily excited by exertion, and might be then so violent, that the patient would fall to the ground insensible." "The rapid action was often commented on; but a slow, hard beat of the heart was also spoken of." The fits of palpitation were associated with cardiac uneasiness and pain, headache, dimness of vision, and giddiness. Pain was an almost constant symptom; often it was the first sign noticed by the patient. It was generally described as occurring in paroxysms, and as sharp and lancinating, tearing or cutting. In the large majority there was a substratum of discomfort or dull heavy pain. Exercise or exertion generally produced an attack of sharp pain, and a fit of palpitation was apt to do the same. "The chief seat of the pain was the lower part of the praecordia, particularly near the apex" . . . and was associated with sensitiveness in the cardiac region. The apical impulse was quick, and abrupt or jerky. "Sometimes the sounds of the heart are split . . . in (one case) the impulse was very irregular; there were double beats and intermissions, and one of the cardiac sounds the

circulation

Where are the diseases of yesteryear? DaCosta's syndrome, soldiers heart, the effort syndrome, neurocirculatory asthenia--and the mitral valve prolapse syndrome.