Precautions To Be Observed

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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