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Source: Disturbances Of The Heart
The symptoms are increased tension, which means, sooner or later,
hypertrophy of the left ventricle and an accentuated closure of the
aortic valve. This alone means more and more tendency to aortic
irritation and aortic valve irritation, with inflammation, and later
deposits of calcareous material, perhaps with stiffening of the
aortic valve and narrowing, aortic stenosis being the result. If
such a patient with the disease advanced to this stage must
overwork, or sustains any severe muscle strain, an aneurysm of the
aorta may occur. In the meantime, with the advancing degeneration of
the cerebral arteries, some sudden cerebral congestion, caused by
leaning over, lifting, vomiting or hard coughing, may rupture a
cerebral vessel, and all the symptoms of apoplexy are present. If
small hemorrhages occur in the arterioles of the extremities, of
course the prognosis is not serious. Sometimes some of the smaller
vessels of the brain may become obstructed and cerebral degeneration
occur. If distal vessels become obstructed, as of the toes or feet,
gangrene takes place unless the obstruction occurs at a place where
the collateral circulation could save the part from such a death.
These are some of the ultimate results of serious and final
arteriosclerosis. The more frequent result, when the disease has not
advanced so far, is a failing heart, either from degenerative
myocarditis, coronary sclerosis or dilatation, with all the symptoms
of coronary sclerosis and angina pectoris, or with the symptoms of
With high blood pressure to the point of beginning endarteritis, a
gradually increasing force of the apex beat occurs, the aortic
closure is accentuated as just described, the pulse is slow, the
tensity of the arteries depends on the stage of the disease, and
when the disease is actually present, the palpable arteries do not
collapse on pressure. They soon lose their elasticity, and if this
occurs in parts which are soft and flexible, the arteries become
more or less tortuous by the force of the blood current twisting and
bending them, owing to the irregularity of their hardening. The
extremities readily become numb, or the part "goes to sleep," as it
is termed. This occurs frequently at night. Sooner or later some
edema of the feet and legs occurs in the latter part of the day.
Sometimes abdominal colic attacks occur, caused by disturbed
circulation. Various disturbances of metabolism may occur, depending
on the circulation in the different organs or on coincident disease,
and the liver, pancreas and kidneys may be affected.
The blood pressure, if taken in the arms especially, may appear
excessively high, but really the actual pressure in the blood
vessels may be low. This is on account of the inability to compress
the hardened arteries. A heart may be weak and actually need
strengthening even while the blood pressure reading is high.
The treatment of this disease is successful only in its prevention,
and consists in treatment of hypertension before arteriosclerosis is
present. When the disease is actually present, there is nothing to
do except for the patient to stop active labor, never to overeat or
overdrink, to prevent, if possible, toxemias from the bowels, to
keep the colon as clean as possible, and for the physician to give
the heart such medicinal aids as seem needed, vasodilators if the
heart is acting too strongly, possibly small doses of cardiac tonics
if the heart is acting weakly; always with the knowledge that a
degenerative myocarditis may be present in considerable amount, or
that coronary sclerosis may be present.
As stated above, coronary sclerosis probably seldom occurs without
more general arteriosclerosis. Obstruction of the coronary arteries,
however, not infrequently occurs at their orifices in conjunction
with sclerosis of that region of the aorta and of the aortic valve.
The more these arteries are diseased and the more they are
obstructed, the more the myocardium of the heart becomes
degenerated, softened and weakened, when dilatation of the
ventricles, especially the left, is liable to occur. Sooner or later
such a condition will cause attacks of angina pectoris and more or
less pronounced symptoms of chronic myocarditis and fatty
degeneration, as previously described.