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The Ammonium Carbonicum

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Punctures Case Vi

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Acute Myocarditis





Category: Uncategorized
Source: Disturbances Of The Heart

Probably most acute infections cause more or less myocarditis,
depending on their intensity and their prolongation. This
disturbance of the heart is often unrecognized, and has been simply
referred to as "the heart growing weaker from the fever process."
The acute infections most likely to cause a myocarditis are
rheumatism, influenza, sepsis, cerebrospinal meningitis, diphtheria,
typhoid fever, scarlet fever, and mouth and throat infections. It is
probably rare when acute endocarditis occurs that more or less
myocarditis is not present. The acute myocarditis may develop some
fatty degeneration, and with this softening and weakening of the
heart muscle acute dilatation readily occurs, which may be a cause
of sudden death, or, if less serious, may be the cause of prolonged
disability, if the heart ever recovers its original size and
strength.

The symptoms are often indefinite, and the diagnosis of the
condition hardly possible. It may be taken for granted, however,
that hardly any serious illness can long continue without cardiac
muscle disturbance. If endocarditis is present, soft systolic
murmurs soon appear. With the acute myocarditis developing, the apex
beat is less positive, less accentuated, and later it becomes
diffuse and even feeble. The closure of the aortic valve is less
typically sharp, showing that the blood vessels are not so
thoroughly filled. The peripheral circulation is not so active, the
blood pressure falls, and the heart becomes more rapid, especially
on the least exertion. All of these signs indicate myocardial
weakness.

The treatment of this condition is largely preventive. It should be
well recognized that prolonged high fever, prolonged insufficient or
improper nutrition, prolonged acute pain, and especially prolonged
septic processes will always cause myocardial degeneration. It
should be recognized that after ether and chloroform anesthesia,
especially after chloroform, the heart muscle may be disturbed and
the tonicity be lost. Therefore after anesthesia, after operations,
and after all illnesses which have lasted more than a few days, the
convalescence of the patient must be more or less deliberate. Sudden
rising, sudden erect posture, the exertion of walking too early,
going up stairs too early or taking moderate, and later severe
exercise too early, may cause dilatation of the heart muscle that
has become weakened by acute myocarditis. If acute myocarditis is
believed or known to be present, cardiac tonics such as digitalis
should not be given; large doses of strychnin should not be given;
vasocontractors such as ergot should not be given; large amounts of
food or large bulks of liquid should not be taken into the stomach
at one time; in fact, unless there is some special indication, the
twenty-four hour amount of fluid should be diminished. The surface
circulation and the muscle circulation should be improved by such
cold or warm water applications as the disease or condition calls
for. Massage should be early inaugurated to promote the return
circulation. The heart should be treated as though it were the
frailest of Venetian glass and would crack with the least rough
handling, or even with a rapid change of temperature, great cold or
too much heat. A prolonged, tedious convalescence, with the return
to activity so graded as to give the heart no strain, and to keep
its work always just below what it is able to do, will often mean
return to perfect strength and health.

No cardiac debilitating drug should be administered when myocarditis
has been surmised or diagnosed. The safest hypnotic, if one is
needed, is morphin in small doses. If there are weakening
perspirations, atropin should be given, especially as it is also a
circulatory stimulant. Calcium in almost any form seems to be of
value in the majority of heart conditions. It is a sedative to the
nervous system, and is certainly indicated in acute myocarditis.
Calcium lactate is perhaps the best salt to administer, in doses of
0.25 gm. (4 grains), three or four times in twenty-four hours.
Calcium glycerophosphate may be used, in powder form or in capsule,
in doses of 0.30 gm. (5 grains) three or four times in twenty-four
hours; or lime-water may be given.

An exact prognosis of this inflammation is impossible. We do not
know how far an acute myocarditis may progress and entire recovery
take place; we do not know how slight a myocarditis may cause
serious symptoms. Clinically we know that many patients after
serious illness never again have perfect circulatory strength. Other
patients almost die of heart failure and yet apparently absolutely
recover their ability to do hard physical work.





Next: Chronic Myocarditis Fibrous

Previous: Myocardial Disturbances



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