Ballistocardiograms After Cigarette Smoking in Health and in Coronary Heart Disease

It has long been known that smoking precipitates anginal attacks in certain patients subject to this disorder, but this occurs only rarely.Smoking also causes changes in the pulse rate and blood pressure of many people (Roth, 1951) and in the electrocardiogram of a few (Evans and Stewart, 1943; Graybiel et al., 1938; and Wilson and Johnston, 1939), some subjects being un- usually susceptible to the agent while others are affected little if at all.Although it is agreed that if smoking precipitates cardiac pain the patient should not smoke, clinical experience with the effect of smoking on other cases of angina has not been sufficiently striking to make most doctors deprive their patients with coronary disease of this comforting habit; although, in the related arteriosclerotic condition of peripheral vascular disease the advice that such patients should stop smoking is now given routinely in many clinics.Because of the irregularity of the effect of nicotine on both healthy persons and those with cardiac disease, one is challenged to ascertain whether the heart of the patient before him is unusually susceptible to its effects or not, and to use this information as the basis for a decision regarding tobacco.The ballistocardiograph has seemed particularly fitted to throw light on this problem, and it was employed for the purpose soon after instruments of this type became available in the clinic.Boyle et al. (1947) and Levy et al. (1946 and 1947) studied both the effect of smoking and of intravenous injection of nicotine itself on healthy persons and patients subject to coronary disease, using the Nickerson low frequency, damped ballistocardiograph (Nickerson, 1945) and making the more usual clinical measurements as well.The results were irregular, some subjects of both healthy and cardiac groups showing marked changes of blood pressure, pulse rate, and the electrocardiogram after exposure to nicotine, but many others being affected little if at all.The cardiac output, calculated from the ballistocardio- gram increased occasionally, but more often remained unchanged; and alterations in ballistic contour were not reported.The averages showed no significant difference between the circulatory dynamics of the response to nicotine in the two groups, but pain was produced in a few patients with coronary disease, and the electrocardiographic changes led to the conclusion that nicotine sometimes induced coronary insufficiency, either by coronary constriction or by increasing the work of the heart.Using a different form of ballistocardiograph, the Dock portable direct-body type, Caccese and Schrager (1951) obtained more striking evidence of cardiac effects, for they demonstrated that changes of ballistic contour occurred after smoking in 18 of 31 subjects.Soon after, Mandlebaum and Mandlebaum (1952), using a ballistocardiograph of the same type, confirmed these results by finding th-t 28 per cent of 50 apparently healthy persons between 16 and 60 years of age, with normal ballistocardiograms before smoking, developed an abnormality of ballistic form after smoking, while in patients with coronary disease, most of whom had abnormal *Working with a Nuffield Foundation Medical Fellowship 278