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Acute MyocarditisCategory: 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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