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Precautions To Be Observed
Source: Disturbances Of The Heart
As long as compensation is complete, there are no medication and
physical treatment necessary for the damaged heart. The patient,
however, should be told of his disability, and restrictions in his
habits and life should be urged on him. The most important are that
all strenuous physical exercise should be interdicted; competitive
athletics should be absolutely prohibited; prolonged muscular effort
must never be attempted, whether running, rowing, wrestling, bicycle
riding, carrying a heavy weight upstairs or overlifting in any form.
The patient should be taught that he should never rush upstairs, and
that he should never run rapidly for a car or a train or for any
other reason; he should not pump up a tire, or repeatedly attempt to
crank a refractory engine; even the prolonged tension of steering a
car for a long distance is inadvisable. He should be told that after
a large meal he is less capacitated for exertion than a man who has
not a damaged heart. It is better if he drinks no tea or coffee; it
is much better if he absolutely refrains from tobacco and alcohol.
Prolonged mental worry, business frets and mental depression are all
injurious to his heart. Anything which seriously excites him,
whether anger or a stimulating drug, is harmful. Any disease which
he may acquire, especially lung disturbances, as pneumonia or even a
serious cough, requires that he take better care of himself and be
more carefully treated and take more rest in bed than a patient who
has not a damaged heart. Anything which raises the blood pressure is
of course more serious for his heart than for a perfect heart;
therefore drinking large amounts of liquid, even water, is
inadvisable. It simply means so much more work for the heart to do.
Such patients should rarely be given any drug that causes cardiac
debility, and should never take one without advice. This applies to
all the coal-tar drugs, acetylsalicylic acid (aspirin), etc.
One other fact should be impressed on the person with a valvular
lesion and compensation, and that is that he has but little, if any,
reserve circulatory power. While he is in apparently perfect health,
it takes little circulatory strain to push his heart to the point of
danger or insufficiency. As nothing keeps this reserve so good or
increases it more than rest, he should expect to have a restful day
at least once a week, and a good rest of at least two or three weeks
once or twice a year.
A patient with these restrictions may live for years with a serious
valvular defect and may die of some intercurrent disease which has
nothing to do with the circulatory system.
It is easily recognizable that as the majority of acute lesions of
the valves occur in children, it is impossible to prevent them from
taking more or less strenuous exercise, and this is probably the
reason that we have so many serious broken compensations during
youth or early adolescence.
As referred to under the subject of myocarditis, many symptoms for
which a patient consults his physician are indefinite and
intangible, though due to cardiac weakness. If a patient with a
damaged heart has a sudden dilatation, of course his symptoms are so
serious that the physician is immediately summoned. If, however, he
has a slowly developing insufficiency of the heart muscle, his first
symptoms are more or less indefinite cardiac pains, slight shortness
of breath, slight attacks of palpitation, a dry, tickling, short
cough occurring after the least exertion, some digestive
disturbances, often sluggishness of the bowels, gastric flatulence,
possibly nosebleeds, and sooner or later some edema of the lower
extremities at the end of the day.
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