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Simple Hypertrophy





Category: Uncategorized
Source: Disturbances Of The Heart

Like any other muscular tissue, the heart hypertrophies when it has
more work to do, provided this work is gradually increased and the
heart is not strained by sudden exertion. To hypertrophy properly
the heart must go into training. This training is necessary in
valvular lesions after acute endocarditis or myocarditis, and is the
reason that the return to work must be so carefully graduated. When
the heart is hypertrophied sufficiently and compensation is perfect,
a reserve power must be developed by such exercise as represented by
the Nauheim, Oertel or Schott methods. Anything that increases the
peripheral resistance causes the left ventricle to hypertrophy.
Anything that increases the resistance in the lungs causes the right
ventricle to hypertrophy. The right ventricle hypertrophy caused by
mitral lesions has already been sufficiently discussed. The right
ventricle also hypertrophies in emphysema, after repeated or
prolonged asthma attacks, perhaps generally in neglected pleurisies
with effusion, in certain kinds of tuberculosis, and whenever there
is increased resistance in the lung tissue or in the chest cavity.

The term "simple hypertrophy" is generally restricted to hypertrophy
of the left ventricle without any cardiac excuse--the hypertrophy by
hypertension and hard physical labor. It is well recognized that it
hypertrophies with hypertension and with chronic interstitial
nephritis. It also becomes hypertrophied when the subject drinks
largely of liquid--water or beer--and overloads his blood vessels
and increases the work the heart must do. This kind of hypertrophy
develops slowly because the resistance in the circulation is gradual
or intermittent. In athletes and in soldiers who are required to
march long distances, hypertrophy generally occurs. This
hypertrophy, if slowly developed by gradual, careful training, is
normal and compensatory. In effort too long sustained, especially in
those untrained in that kind of effort, and even in the trained if
the effort is too long continued, the left ventricle will become
dilated and the usual symptoms of that condition occur. Such
dilatation is always more or less serious. It may be completely
recovered from, and it may not be. Therefore it proper understanding
of the physics of the circulation by the medical trainer of young
men to decide whether or not one should compete in a prolonged
effort, as a rowing race, for instance, is essential. It is wrong
for any young athlete to have an incurable condition occur from
competition.

Sometimes simple hypertrophy of the left ventricle occurs from
various kinds of conditions that increase the peripheral
circulation. It may occur from oversmoking, from the mertisc of
coffee aid tea, from certain kinds of physical labor, or from high
tension mental work. It is a part of the story of hypertension. Many
times such patients, as well as occasionally trained athletes, and
sometimes patients with arteriosclerosis or chronic interstitial
nephritis complain of unpleasant throbbing sensations of the heart
added to these sensations are a feeling of fulness in the head,
flushing of the face, and possibly dizziness--all symptoms not only
of hypertension but of too great cardiac activity. Various drugs
used to stimulate the heart may cause this condition; when digitalis
is given and is not indicated or is given in overdosage, these
symptoms occur.

The treatment is simply to lower the diet, cause catharsis, give hot
baths, stop the tobacco, tea and coffee, stop the drinking of large
amounts of liquid at any one time, and administer bromids and
perhaps nitroglycerin, when all the symptoms of simple hypertrophy
will, temporarily at least, disappear.

If the heart is enlarged from hypertrophy, if it is the right
ventricle that is the most hypertrophied, the apex is not only
pushed to the left, but the beat may be rather diffuse, as the
enlarged right ventricle will prevent the apex from acting close to
the surface of the chest. If the left ventricle is the most
hypertrophied, the apex is also to the left, but the impact is very
decided and the aortic closure is accentuated.





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