Myocarditis Fibrous Management


Categories: Uncategorized
Sources: 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.





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