Cardiac vomiting.

This survey was stimulated by a recent article on vomiting as a diagnostic aid in acute cardiac ischaemia in which the incidence of vomiting in 109 consecutive coronary care unit patients was prospectively related to the nature and site of infarction. ' In transmural infarction, about half the patients had vomited, even before the use of analgesic drugs. This high incidence was not seen in subendocardial infarction and the authors concluded that "the vomiting reflex, if such exists, might arise as a consequence of damage to the subpericardial tissue". The authors briefly referred to the possibility of the nausea and autonomic disturbance being related to the BezoldJarisch reflex. It may be of interest to review the now extensive physiological data on this subject, which has clinical relevance to many other circulatory disturbances.