Acute Dilatation Of The Heart In Acute Disease

Categories: Uncategorized
Sources: Disturbances Of The Heart

It has for a long time been recognized that in all acute prolonged

illness the heart fails, sooner or later, often without its having

been attacked by the disease. The prolonged high temperature causes

the heart to beat more rapidly, while the toxins produced by the

fever process cause muscle degeneration of the heart or a

myocarditis, and at the same time the nutrition of the heart becomes

impaired either by improper eeding or by the imperfect metabolism

of the food given; hence the heart muscle becomes weakened, and

cardiac failure or cardiac relaxation or dilatation occurs.



The specific germ of the disease, or the toxin elaborated by this

germ, may be especially depressant to the heart, as in diphtheria,

or the germ may be particularly prone to locate in the heart, as in

rheumatism and pneumonia. But all feverish processes, sooner or

later, if sufficiently prolonged, cause serious cardiac weakness and

more or less dilatation.



Just exactly what changes take place in the muscle fibers of the

heart in some of these fevers has not been decided. Whether an

albuminous or parenchymatous degeneration of the muscle fibers or a

fatty degeneration occurs, whether there is a real myocarditis that

always precedes the dilatation, or whether the weakening and loss of

muscle fibers or a diminished power of the muscle fibers occurs

without inflammation, dilatation of the heart is always a factor to

be considered, and frequently occurs in acute disease.



While it is denied that acute dilatation can occur in a sound heart,

at the latter end of a serious illness the heart is never sound, and

acute dilatation can most readily occur, though fortunately it is

generally preventable. When the dilatation occurs suddenly, as

indicated by a fluttering heart, a low tension, rapid pulse, dyspnea

and perhaps cyanosis with venous stasis in the capillaries, death is

imminent, although such patients may be saved by proper aid. Even

when the dilatation is slower, as evidenced by a gradually

increasing rapidity of the heart and a gradually lowering blood

pressure, and with more evidences of exhaustion, death may occur

from such heart failure in spite of all treatment.



Unless a patient dies from accident, as from a hemorrhage, from

cerebral pressure or from some organic lesion in acute disease, the

physician frequently feels that if he can hold the power and force

of the circulation for several hours or days, the patient will

recover from the disease, for in most acute diseases the patient has

a good chance of recovery if his circulation will only hold out

until the crisis has occurred or until the disease is ready to end

by lysis. Therefore anything during the disease that tends to

sustain, nourish, quiet and guard the heart means so much more

chance of recovery, whatever else may or may not be done for the

disease itself.



The best treatment of dilatation of the heart in acute disease is

its prevention, and to prevent it means to recognize the condition

which can cause it. These are



1. Prolonged high temperature. A short-lived temperature, even if

high, is not serious. Prolonged temperature of even 103 F. or more

is serious, and even that of 101 is serious if too long continued.



2. Exertion and excitement. Every possible means should be

inaugurated to prevent muscular exertion and strain of the patient

while in bed. Proper help in lifting and turning the patient should

be employed, the bed-pan should be used, proper feeding methods

should be adopted, and friends should be excluded so that the

patient may not be excited by conversation.



3. Bad feeding. The diet should of course be sufficient, for the

patient and proper for the disease, but any diet which causes a

large amount of gas in the stomach, or tympanites, is harmful to the

patient's circulation, to say nothing of any other harm, such as

indigestion may do. All of the nutriments needed to keep the body in

perfect condition should be given to a patient who is ill; in some

manner he should receive the proper amounts of iron, salt, calcium,

starch, protein, sugar and water.



4. Intestinal sluggishness. This means not only that tympanites

should not be allowed, but also that necessary laxatives should be

given. It would be wrong to prostrate a patient with frequent saline

purgatives, but the bowels must move at least once every other day,

generally better daily; and if the case is one of typhoid fever,

they should be moved by some carefully selected laxative, and after

the bowels have sufficiently moved, the diarrhea should be stopped

by 1/10 grain of morphin, and the next day the bowels properly moved

again.



5. Depressant drugs. In this age of cardiac failure, heart

depressants of all types, and especially the synthetic products,

should be given only with careful judgment, and, never frequently

repeated or long continued.



6. Pain. This is one of the most serious depressants a heart has to

combat; acute pain must not be allowed, and prolonged subacute pain

must be stopped. Even peripheral troublesome irritations must be

removed, as tending to wear out a heart which has all of the trouble

it can endure.



7. Insomnia. Nothing rests a heart or recuperates a heart more than

sleep. Insomnia and acute disease make a combination which will wear

a heart out more quickly than any other combination. Sleep, then,

must be produced in the best, easiest and safest manner possible.



8. A too speedy return to activity. The convalescence must be

prolonged until the heart is able to sustain the work required of

it.



The treatment of gradual dilatation in acute disease has been

sufficiently discussed under the subject of acute myocarditis. The

treatment of acute dilatation is practically the same as the

treatment of shock plus whatever treatment must coincidently be

given to a patient for the disease with which he is suffering. The

treatment of shock will be discussed under a separate heading.