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Myocarditis Fibrous Management
Source: Disturbances Of The Heart
The advice he should receive is well understood: to avoid physical
efforts; to avoid mental tire; to avoid overeating or overdrinking
of any foods or liquids; to reduce or abstain from alcohol, coffee,
tea and tobacco, depending on what seems advisable in the individual
case; to reduce the amount of meat eaten, especially if there is
intestinal indigestion; to relieve intestinal indigestion; to cause
free daily movements of the bowels; to abstain from any food which
tends to cause gastric or intestinal flatulence; to abstain from
such foods as contain nucleins, if the patient is gouty; to take
frequent warm baths (not too hot) to promote the secretions and the
circulation in the skin, and to take such daily exercise as seems
advisable. If the patient cannot take exercise, simple calisthenics
or massage should be instituted.
Whether nitroglycerin or other nitrite is advisable depends on the
peripheral blood pressure. If the blood pressure is low, or not
higher than is best for the patient, such treatment would be
inadvisable. If, from the supposed cause, iodid seems to be
indicated, it should be given in small doses and continued for some
time. It is often wise, however, to give small doses, as 0.10 or
0.20 gm. (2 or 3 grains) once or twice in twenty-four hours, for a
long period, to any patient who leas fibrosis or selerosis in any
form. Iodid tends to prevent the progress of connective tissue
formation. It is quite possible that some of its value is in
activating a sluggish or imperfectly acting thyroid gland. If the
patient is old, his thyroid is subinvoluting, and a little more of
its activity will be of advantage. Many diseases which cause chronic
myocarditis also cause, later, subactivity of the thyroid. Thyroid
extract may be indicated if the patient is obese.
If, in spite of this management and treatment, the patient has
cardiac asthma attacks, with or without pain, especially if there
are pendent edemas, the question arises as to whether or not
digitalis should be given. In such cases one cannot tell without
trying whether digitalis will be of benefit or will cause more
discomfort. 11 small dose of an active preparation should be given
at first twice in twenty-four hours, and after a week once in
twenty-four hours, its action being carefully watched and the
decision as to whether the dose is too large or too small arrived
at. It may do a great amount of good; it can cause increased cardiac
pains. If used carefully and stopped when it appears not to be
acting well, it will do no harm.
Chilling of the surface of the body should be avoided; sudden cold
or sustained severe cold, which increases the contraction of the
peripheral blood vessels and puts more strain on the heart muscle,
is to be avoided if possible. More hours in bed at night and lying
down after the heavier meals of the day will tend to give the heart
the kind of rest it needs. Also complete rest for one day a week, or
a rest of several days at a time, and a rest, both mental and
physical, with such walking, golfing or riding as seems advisable,
for at least one month every year, will prolong the lives of these
patients, and may make an imperfect heart act well for months and
years. If the patient is anemic he should, of course, receive some
nonastringent iron; a. tablet of saccharated ferric oxid
(Eisenzucker), in small doses, 0.20 gm. (3 grains), once or twice in
twenty-four hours, is sufficient.
The prognosis of a case diagnosed as chronic myocarditis or chronic
degeneration of the heart is doubtful, as one cannot tell until
several weeks or months of observation whether this particular heart
also has fatty degeneration or not. If there is fatty degeneration,
the prognosis is bad. If there is no serious fatty degeneration, the
patient, with the modified life outlined, may live for a long time.
Acute dilatation from any serious strain on the heart may occur, and
if there is fatty degeneration it is liable to occur at any time.
Attacks of cardiac asthma are always serious, and always damage the
heart a little more.
Next: Fatty Degeneration
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