Simple Hypertrophy


Categories: Uncategorized
Sources: 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.





More

;