There is a condition similar to angina pectoris, sometimes called pseudo-angina, or false heart pang, which occurs in individuals from fifteen to thirty years of age. It is often a {143} source of great worry. It occurs in young persons of a nervous temperament who have been overworked or overworried and have run down in weight. There are always accompanying signs of gastric disturbance. The casual factor of the symptoms seems to be a more or less sudden dilation of the stomach with gas. As the stomach lies just below the heart, only separated from it by the comparatively thin layer of diaphragm, the heart is pushed up and its action interfered with. In healthy individuals this causes no more than a passing sense of discomfort and some heart palpitation. That it is which sends so many young patients to physicians with the persuasion that they have heart disease, when they have nothing more than indigestion. In nervous individuals, however, this interference with the heart action disturbs the nervous mechanism of the heart, which is very intricate and delicate, and gives rise to the symptoms of false "heart pang." One of these symptoms is always, as in true angina pectoris, an impending sense of death. This can not be shaken off, and is not merely an imagination of the patient. Pseudo-angina is, however, not a dangerous affection. Patients can usually be assured that there is no danger of death. This assurance is not absolute, however. For some of these cases have congenital defects in their coronary arteries, and the nervous system of the heart itself, which make them liable to sudden death. It is sometimes impossible to differentiate such cases of organic heart defects from the ordinary functional heart disturbance due to indigestion, which causes simple curable pseudo-angina. Young patients may usually be disabused of their nervousness in the matter, but absolute assurance can not be given until the case has been under observation for some time.