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Source: Disturbances Of The Heart
This rarely, if ever, occurs alone; it is generally a sequence of
other valvular defects, and represents an overworked, dilated right
ventricle. It may, however, occur from lesions of the lungs which
impede the blood flow through them. Such are fibroid changes in the
lungs, emphysema, prolonged chronic bronchitis, the last stages of
pulmonary tuberculosis, old neglected pleurisies with cirrhosis or
fibrosis of the lung, and repeated attacks of asthma--anything,
whether valvular defect or pulmonary circulatory disturbance, which
increases the pressure ahead and the work of this ventricle.
The symptoms are those of loss of compensation as described under
other valvular lesions. There may be jugular pulsation, especially
evident in the external jugular on the left side. The liver enlarges
and may pulsate. There are edemas, dropsies, ascites and perhaps
hemorrhages. The heart is enlarged and there is a soft systolic blow
heard at the lower end of the sternum. The dyspnea is sometimes very
great, and cyanosis may be present, especially during paroxysms of
This lesion of the heart is always benefited by digitalis, but the
continuance of the improvement and its amount depend, of course, on
the cause of the dilatation of the ventricle. Strychnin is often of
advantage. These patients should rarely receive vasodilators, and
hot baths, overheating, overloading the stomach and vigorous purging
should never be allowed. Sometimes improvement will not take place
until ascitic or pleuritic fluid, if present, has been removed.
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