In 1888, what does "smothering at the heart" mean?

Question

The following is the front side of a surgeon's certificate for my 3x-great grandfather (and part of a civil war pension application for his widow). It was created in 1888. At one point, he describes his condition by saying

I have something of a smothering at my heart once in a while.

I have never heard this expression before, but my guess is that it means he sometimes has a hard time breathing because his chest becomes tight (as though someone were "smothering" him "at his chest").

Does this seem right? Is the some reliable source that explains this phrase?

There is only one search result on Google for the this phrase, and it comes from a play written in 1800.

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Transcript

Pulse rate per minute, 102; respiration, 24; temperature, 98.2; height, 5 feet 10 inches; weight, 175 pounds; age, 54 years.

He makes the following statement upon which he bases his claim for original:
I have it in my back and legs so bad that it sometimes lays me up for a week at a time I have some knots on my legs from Rheumatism I have something of a smothering at my heart once in a while. Don’t know whether from Rheumatism or not. Rheumatism sometimes also affects my shoulder

Upon examination we find the following objective conditions: No deformity or change of structure anywhere excepting a very slight soft puffiness in both popliteal places. There is a slight crepitation in both shoulder joints although he is not complaining of any pain in either. There is no change in area of heart but his pulse is 102 at rest and as high as 120 during examination. It doesn’t seem to be irregular in any way more than rapid. We detect no abnormal sound. We believe this is the result of Rheumatism
Dis 10/18

From the existing condition and the history of this claimant, as stated by himself, it is, in our judg- ement, ____________ probable that the disability was incurred in the service as he claims, and that it has not been prolonged or aggravated by vicious habits. He is, in our opinion, entitled to a 10/18 rating for the disability caused by Irritable heart Result of Rheumatism

Answer 1

I think you are correct in your assessment that "smothering at the heart" refers to a restrictive sensation in the chest, perhaps a shortness of breath.

The links between "rheumatism" – a very general term for musculoskeletal pain or stiffness – and heart disease are well described in the medical literature. Voskuyl (2006) provides a nice overview of links between rheumatoid arthritis and many types of heart disease (pericarditis, cardiomyopathy, myocarditis, cardiac amyloidosis, coronary vasculitis, arrythmia and valve diseases, congestive heart failure, ischaemic heart disease).

It is very difficult to determine what the underlying heart disease was based on the little information given. The patient was tachycardic (increased heart rate), but no arrhythmia or heart murmur was auscultated.

More interesting to me than the smothering at the heart is the final diagnosis: "Irritable heart result of rheumatism."

Irritable heart syndrome was a common reason for discharge of soldiers in the US Civil War and beyond, and was characterized by heart palpitations, shortness of breath, increased pulse, chest pains, fatigue, and other vague signs. These symptoms are not inconsistent with your soldier's. The aetiology of irritable heart syndrome is not known but it has been suggested that some cases may have been secondary to a post-traumatic stress. An interesting discussion of this syndrome is Irritable heart syndrome in Anglo-American medical thought at the end of the nineteenth century by Yuri C. Vilarinho (2014).

Even in the nineteenth century there was a wealth of medical literature about heart disease in soldiers. One work you may find of interest is On the etiology and prevalence of diseases of the heart among soldiers by Arthur B. R. Myers (1870).

Whether this soldier's heart disease was truly secondary to rheumatism or not is impossible to say. When interpreting medical records from the nineteenth century it is important to not over-interpret what is written and jump to conclusions. There is little one can conclude with any certainty from this record other than the fact that the patient had rheumatism and heart disease.