There is a form of this functional disturbance of the heart which reaches a climax of power to disturb and then is sometimes spoken of as spurious _angina pectoris_. In these cases the patient complains not only of a sense of discomfort but of actual pain over the heart region and this pain is sometimes spoken of as excruciating. Occasionally the pain will be reflected down the left arm which used to be considered the pathognomic sign of true _angina pectoris_ but is not. Sometimes the pain is reflected in the neck on the left side or at times is noted at the angle of the scapula behind. When these symptoms occur {231} in young persons and particularly in young women, there is no reason to think for a moment of their being due to true _angina pectoris_, which is a spasm of the heart muscle consequent upon the degeneration of the coronary arteries, the blood vessels which feed the heart itself, and occurs almost exclusively in the old, and much more commonly in old men. The pain of true _angina pectoris_ is often said to be perhaps the worst torture that humanity has to bear. As a rule, however, it is very prostrating and so genuine sufferers from it are not loud in their complaints. Their suffering is more evident in their faces than in their voices. Indeed, it has come to be looked upon as a rule by the English clinicians and heart experts that the more fuss there is made, the less likelihood there is of the affection being true _angina pectoris_. When there is pain in the heart region then, especially in young or comparatively young women, of which great complaint is made, it is almost surely to be considered spurious _angina_, even though there may be reflex pain down the arm as well as the impending sense of death which used to be considered distinctive of the genuine _angina pectoris_. {232}