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Physical Signs Of Bronchial Foreign Body
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The Coal Foods
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Compression Stenosis Of The Esophagus
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Burns Case Xxxiv
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The Wet Compress
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Acute Dilatation Of The Heart In Acute Disease
Source: Disturbances Of The Heart
It has for a long time been recognized that in all acute prolonged
illness the heart fails, sooner or later, often without its having
been attacked by the disease. The prolonged high temperature causes
the heart to beat more rapidly, while the toxins produced by the
fever process cause muscle degeneration of the heart or a
myocarditis, and at the same time the nutrition of the heart becomes
impaired either by improper feeding or by the imperfect metabolism
of the food given; hence the heart muscle becomes weakened, and
cardiac failure or cardiac relaxation or dilatation occurs.
The specific germ of the disease, or the toxin elaborated by this
germ, may be especially depressant to the heart, as in diphtheria,
or the germ may be particularly prone to locate in the heart, as in
rheumatism and pneumonia. But all feverish processes, sooner or
later, if sufficiently prolonged, cause serious cardiac weakness and
more or less dilatation.
Just exactly what changes take place in the muscle fibers of the
heart in some of these fevers has not been decided. Whether an
albuminous or parenchymatous degeneration of the muscle fibers or a
fatty degeneration occurs, whether there is a real myocarditis that
always precedes the dilatation, or whether the weakening and loss of
muscle fibers or a diminished power of the muscle fibers occurs
without inflammation, dilatation of the heart is always a factor to
be considered, and frequently occurs in acute disease.
While it is denied that acute dilatation can occur in a sound heart,
at the latter end of a serious illness the heart is never sound, and
acute dilatation can most readily occur, though fortunately it is
generally preventable. When the dilatation occurs suddenly, as
indicated by a fluttering heart, a low tension, rapid pulse, dyspnea
and perhaps cyanosis with venous stasis in the capillaries, death is
imminent, although such patients may be saved by proper aid. Even
when the dilatation is slower, as evidenced by a gradually
increasing rapidity of the heart and a gradually lowering blood
pressure, and with more evidences of exhaustion, death may occur
from such heart failure in spite of all treatment.
Unless a patient dies from accident, as from a hemorrhage, from
cerebral pressure or from some organic lesion in acute disease, the
physician frequently feels that if he can hold the power and force
of the circulation for several hours or days, the patient will
recover from the disease, for in most acute diseases the patient has
a good chance of recovery if his circulation will only hold out
until the crisis has occurred or until the disease is ready to end
by lysis. Therefore anything during the disease that tends to
sustain, nourish, quiet and guard the heart means so much more
chance of recovery, whatever else may or may not be done for the
The best treatment of dilatation of the heart in acute disease is
its prevention, and to prevent it means to recognize the condition
which can cause it. These are
1. Prolonged high temperature. A short-lived temperature, even if
high, is not serious. Prolonged temperature of even 103 F. or more
is serious, and even that of 101 is serious if too long continued.
2. Exertion and excitement. Every possible means should be
inaugurated to prevent muscular exertion and strain of the patient
while in bed. Proper help in lifting and turning the patient should
be employed, the bed-pan should be used, proper feeding methods
should be adopted, and friends should be excluded so that the
patient may not be excited by conversation.
3. Bad feeding. The diet should of course be sufficient, for the
patient and proper for the disease, but any diet which causes a
large amount of gas in the stomach, or tympanites, is harmful to the
patient's circulation, to say nothing of any other harm, such as
indigestion may do. All of the nutriments needed to keep the body in
perfect condition should be given to a patient who is ill; in some
manner he should receive the proper amounts of iron, salt, calcium,
starch, protein, sugar and water.
4. Intestinal sluggishness. This means not only that tympanites
should not be allowed, but also that necessary laxatives should be
given. It would be wrong to prostrate a patient with frequent saline
purgatives, but the bowels must move at least once every other day,
generally better daily; and if the case is one of typhoid fever,
they should be moved by some carefully selected laxative, and after
the bowels have sufficiently moved, the diarrhea should be stopped
by 1/10 grain of morphin, and the next day the bowels properly moved
5. Depressant drugs. In this age of cardiac failure, heart
depressants of all types, and especially the synthetic products,
should be given only with careful judgment, and, never frequently
repeated or long continued.
6. Pain. This is one of the most serious depressants a heart has to
combat; acute pain must not be allowed, and prolonged subacute pain
must be stopped. Even peripheral troublesome irritations must be
removed, as tending to wear out a heart which has all of the trouble
it can endure.
7. Insomnia. Nothing rests a heart or recuperates a heart more than
sleep. Insomnia and acute disease make a combination which will wear
a heart out more quickly than any other combination. Sleep, then,
must be produced in the best, easiest and safest manner possible.
8. A too speedy return to activity. The convalescence must be
prolonged until the heart is able to sustain the work required of
The treatment of gradual dilatation in acute disease has been
sufficiently discussed under the subject of acute myocarditis. The
treatment of acute dilatation is practically the same as the
treatment of shock plus whatever treatment must coincidently be
given to a patient for the disease with which he is suffering. The
treatment of shock will be discussed under a separate heading.
Next: The Heart In Pneumonia
Previous: Simple Dilatation