Simple Dilatation
Categories: UncategorizedSources: Disturbances Of The Heart
The term "simple dilatation" may be applied to the dilatation of one
or both ventricles when there is no valvular lesion and when the
condition may not be called broken compensation. The compensation
has been sufficiently discussed. Dilatation of the heart occurs when
there is increased resistance to the outflow of the blood front the
ventricle, or when the ventricle is overfilled with blood and the
muscular wall is un
it. In other words, it may be weakened by myocarditis or fatty
degeneration; or it may be a normal heart that has sustained a
strain; or it may be a hypertrophied heart that has become weakened.
Heart strain is of frequent occurrence. It occurs in young men from
severe athletic effort; it occurs in older persons from some severe
muscle strain, and it may even occur from so simple an effort as
rapid walking by one who is otherwise diseased and whose heart is
unable to sustain even this extra work. All of the conditions which
have been enumerated as causing simple hypertrophy may have
dilatation as a sequence.
Degeneration and disturbance of the heart muscle and cardiac
dilatation are found more and more frequently at an earlier age than
such conditions should normally occur. Several factors are at work
in causing this condition. In the first place, infants and children
are now being saved though they may have inherited, or acquired, a
diminished withstanding power against disease and against the strain
and vicissitudes of adult life. Other very important factors in
causing the varied fortes of cardiac disturbances are the rapidity
and strenuousness of a business and social life, and competitive
athletics in school and college, to say nothing of the oversmoking
and excessive dancing of many.
The symptoms of heart strain, if the condition is acute, are those
of complete prostration, lowered blood pressure, and a sluggishly,
insufficiently acting heart. The heart is found enlarged, the apex
beat diffuse and there may be a systolic blow at the mitral or
tricuspid valve. Sometimes, although the patient recognizes that he
has hurt himself and strained his heart, he is not prostrated, and
the full symptoms do not occur for several hours or perhaps several
days, although the patient realizes that he is progressively growing
weaker and more breathless.
The treatment of this acute or gradual dilatation is absolute rest,
with small doses of digitalis gradually but slowly increased, and
when the proper dosage is decided on, administered at that dosage
but once a day. Cardiac stimulants should not be given, except when
faintness or syncope has occurred, and if strychnin is used, it
should be in small closes. The heart nay completely recover its
usual powers, but subsequently it is more readily strained again by
any thoughtless laborious effort. The patient must be warned as
carefully as though he had a valvular lesion and had recovered from
a broken compensation, and his life should be regulated accordingly,
at least for some months. If he is young, and the heart completely
and absolutely recovers, the force of the circulation may remain as
strong as ever.
Sometimes the heart strain is not so severe, and after a few hours
of rest and quiet the patient regains complete cardiac power and is
apparently as well as ever; but for some time subsequently his heart
more easily suffers strain.
Chronic dilatation of the heart, However, perhaps not sufficient to
cause edema, slowly and insidiously develops from persistent
strenuosity, or from the insidious irritations caused by absorbed
toxins due to intestinal indigestion. A fibrosis of the heart muscle
and of the arterioles gradually develops, and the heart muscle
sooner or later feels the strain.
It is now very frequent for the physician, in his office, to hear
the patient say, "Doctor, I am not sick, but just tired," or, "I get
tired on the least exertion." We do not carefully enough note the
condition of the heart in our patients who are just "weary," or even
when they show beginning cardiovascular-renal trouble.
The primary symptoms of this condition of myocardial weakening are
slight dyspnea on least exertion; slight heart pain; slight edema
above the ankles; often some increased heart rapidity, sometimes
without exertion; after exertion the heart does not immediately
return to its normal frequency; slight dyspnea on least exertion
after eating; flushing of the face or paleness around the mouth, and
more or less dilatation of the veins of the hands. All of these are
danger signals which may not be especially noted at first by the
individual; but, if he presents himself to his physician, such a
story should cause the latter not only to make a thorough physical
examination, but also to note particularly the size of the heart.
It a roentgenographic and fluoroscopic examination cannot be made,
careful percussion, noting the region of the apex beat, noting the
rapidity and action of the heart on sitting, standing and lying, and
noting the length of time it takes while resting, after exertion,
for the speed of the heart to slacken, will show the heart strength.
Slight dilatation being diagnosed, the treatment is as follows
1. Rest, absolute if needed, and the prohibition of all physical
exercise and of all business cares.
2. Reduction in the amount of food, which should be of the simplest.
Alcohol should be stopped, and the amount of tea, coffee and tobacco
reduced.
3. If medication is needed, strychnin sulphate, 1/40, or 1/30 grain
three times a day, acid the tincture of digitalis in from 5 to 10
drop doses twice a day will aid the heart to recover its tone.
Such treatment, when soon applied to a slowly dilating and weakening
heart, will establish at least a temporary cure and will greatly-
prolong life.
If these hearts are not diagnosed and properly treated, such
patients are liable to die suddenly of "heart failure," of acute
stomach dilatation, or of angina pectoris. Furthermore, unsuspected
dilated hearts are often the cause of sudden deaths during the first
forty-eight hours of pneumonia.
Small doses of digitalis are sufficient in these early cases. If
more heart pain is caused, the dose of digitalis is too large, or it
is contraindicated. Digitalis need not be long given in this
condition, especially as Cohen, Fraser and Jamison [Footnote: Cohen,
Fraser and Jamison: Jour. Exper. Med., June, 1915.] have shown by
the electrocardiograph that its effect on the heart may last twenty-
two days, and never lasts a shorter time than five days. They also
found that when digitalis is given by the mouth, the
electrocardiograph showed that its full activity was not reached
until from thirty-six to forty-eight hours after it had been taken.
From these scientific findings it will he seen that if it is
necessary to give a second course of treatment with digitalis,
within two weeks at least from the time the last close of digitalis
was given, the dose of this drug should be much smaller than when it
was first administered.
Owing to our strenuous life, if persons over 40 would present
themselves for a heart and other physical examination once or twice
a year there would not be so many sudden deaths of those thought to
be in good health. It may be a fact as asserted by many of our best
but depressing and pessimistic clinicians, that chronic myocarditis
and fatty degeneration of the heart cannot be diagnosed by any
special set of symptoms or signs. However, it is a fact that a
tolerably accurate estimate of the heart strength can be made by a
careful physician, and if danger signals are noted and signs of
probable heart weakness are present, life may be long saved by good
treatment or management rigorously carried out. The patient must
cooperate, and to get him to do this he must be tactfully warned of
his condition. Many, such patients, noting their impaired ability,
do not seek medical advice, but think all they need is more
exercise; hence they walk, golf, and dance to excess and to their
cardiac undoing.
More
-
Renal Calculi Gravel In The Kidneys
Take the A C current, of considerable force. Place N. P. low upon the bladder, and treat with P. P. upon the inflamed and painful point five to eight minutes, once or twice a day. If treating twice a day, continue not more than five minutes at a tim... Resistance
A MAN once grasped a very hot poker with his hand, and although he cried out with pain, held on to the poker. His friend called out to him to drop it, whereupon the man indignantly cried out the more. "Drop it? How can you expect me to th... Rest In Sleep
HOW do we misuse our nervous force? First, let us consider, When should the body be completely at rest? The longest and most perfect rest should be during sleep at night. In sleep we can accomplish nothing in the way of voluntary activity ei... Resume Of After-care Of A Tracheotomic Case
1. Always bear in mind that tracheotomy is not an ultimate object. The ultimate object is to pipe air down into the lungs. Tracheotomy is only a means to that end. 2. Sterile tray beside bed should contain duplicate (exact) tracheotomy tube, Tr... Resume Of Emergency Tracheotomy
The following notes should be memorized. 1. Essentials: Knife and pair of hands (but full equipment better). [295] 2. Don't do a laryngotomy, or stabbing. 3. Two stage, finger guided operation better. 4. Sand bag or substitute. 5. Press ... Resume Of Tracheotomy
Instruments. Headlight Sandbag Scalpel Hemostats Small retractors Tenaculum Tracheotomic cannulae (proper kind) Long. Half area cross-section trachea. Proper curve: Radius too short will press ant. tracheal wall; too... Retrograde Esophagoscopy
The first step is to get rid of the gastric secretions. There is always fluid in the stomach, and this keeps pouring out of the tube in a steady stream. Fold after fold is emptied of fluid. Once the stomach is empty, the search begins for the cardi... Rheumatism Acute Inflammatory
First ascertain if the kidneys be morbidly positive--urine scant and too highly colored. If so, as is commonly the case, begin with the B D current, good medium force. Place N. P. at the pelvis, and treat over the kidneys with P. P. some three or fo... Rheumatism Chronic
Use the A D current always in rheumatic affections. If there be no visible inflammation or swelling in the diseased parts, approach such parts in the same manner as in acute inflammatory rheumatism, except with reversed poles. The parts affected req... Rhus Tox
applied, with water at the strength of thirty drops of the _tr._ to a gill, to parts affected with _Rheumatism_, acts very beneficially. It is also a most valuable application at half the above strength upon parts affected with Erysipelas, when the ... Roentgenray Study In Foreign Body Cases
Roentgenography.--All cases of chest disease should have the benefit of a roentgenologic study to exclude bronchial foreign body as an etiological factor. Negative opinions should never be based upon any plates except the best that the wonderful mod... Rotation Forceps
It is sometimes desired to make traction on an irregularly shaped foreign body, and yet to allow the object to turn into the line of least resistance while traction is being made. This can be accomplished by the use of the rotation forceps (Fig. 20)... Rubbing Sheet Substitute For The Half-bath
It cannot be difficult to procure a wash-tub. Should you be so situated, however, as not to be able to procure even this, you will be compelled to make shift with a _rubbing sheet_. For that purpose, a sheet and a pail of water are all you need. The... Rules For Direct Laryngoscopy
1. The laryngoscope must always be held in the left hand, never in the right. 2. The operator's right index finger (never the left) should be used to retract the patient's upper lip so that there is no danger of pinching the lip between the instr... Rules For Endoscopic Foreign Body Extraction
1. Never endoscope a foreign body case unprepared, with the idea of taking a preliminary look. 2. Approach carefully the suspected location of a foreign body, so as not to override any portion of it. [175] 3. Avoid grasping a foreign body has... Rules For Insertion Of The Catheter For Insufflation Anesthesia
1. The patient should be fully under the anesthetic by the open method so as to get full relaxation of the muscles of the neck. 2. The patient's head must be in full extension with the vertex firmly pushed down toward the feet of the patient, so... Rules For The Application Of Water In Typhoid Cases
As a general rule, in typhoid cases, bathing should form one of the principal features of the treatment; i. e. the patient should have more baths than packs in proportion to the treatment of other cases. The temperature of the baths should be in... Running The Human Automobile
The Body-Automobile. If you were to start to-morrow morning on a long-distance ride in an automobile, the first thing that you would do would be to find out just how that automobile was built; how often it must have fresh gasoline; how its differe... Rupture And Trauma Of The Esophagus
These may be spontaneous or may ensue from the passage of an instrument, or foreign body, or of both combined, as exemplified in the blind attempts to remove a foreign body or to push it downwards. Digestion of the esophagus and perforation may resu... Safety-pin Closer
There are a number of methods for the endoscopic removal of open safety-pins when the point is up, one of which is by closing the pin with the instrument shown in Fig. 37 in the following manner. The oval ring is passed through the endoscope until i... Scald Head
of children, where there is a discharge of yellow and watery pus from the sores, and the eruption extends to the ears or face, like the disease called the _crusta lactea_ (milk crust), the same washes as for itch, are the most effectual, while at th... Scarlatina Anginosa Or Sore-throat Scarlet-fever
Wherever the _throat_ is affected, which is almost always the case, the disease is called _scarlatina anginosa_, or _sore-throat scarlet-fever_. This is the form described at the commencement of this article. There are several varieties, however, of... Scarlatina Miliaris
Sometimes the red patches of the rash are covered with small vesicles of the size of mustard-seed, which either dry up or discharge a watery liquid, leaving thin white scurfs, that come away with the cuticle during desquamation. Although this form, ... Scarlatina Simplex Or Simple Scarlet-fever
In the _mildest form_ of the disease, called _scarlatina simplex_, or _simple scarlet-fever_, there is no inflammation of the throat, the fever is moderate, and the patient suffers very little. Unfortunately this form is so rare, that many experienc... Scarlatina Sine Exanthemate
There are also mild cases of scarlet-fever, when little or no rash appears, and the throat is very little affected. These are the result of a particularly mild character of the epidemy, together with a peculiar condition of the skin, the desquamatio... Scarlet Fever
This fever assumes two principal forms: Simple or mild, and Malignant. In the _Simple form_, there is great heat of the surface, extremely quick and frequent pulse, headache, and some sense of pain and soreness in the throat. After a day or two, the... Scarlet-fever Or Scarlatina
is an eruptive fever, produced by a peculiar contagious poison, and distinguished by extreme heat, a rapid pulse, a severe affection of the mucous membranes, especially those of the mouth and throat, and by a burning scarlet eruption on the skin. ... Sciatica
This is neuralgia in an ischiatic nerve, commonly the great ischiatic. Use the B D current, strong as the patient can well bear. Place the foot in warm water with N. P., or place the sponge-roll N. P. at the sole of the foot, (the former is the be... Sea-sickness
_Nux Vomica_ should be used once in about four hours, for twelve hours before sailing, as a preventive to sea-sickness. If, however, symptoms, such as dizziness or blur before the eyes, and headache, begin to come on, a dose of _Nux_ should be tak... Second Stage
The spatular end of the laryngoscope should now be tipped back toward the posterior wall of the pharynx, passed posterior to the epiglottis, and advanced about 1 cm. The larynx is now exposed by a motion that is best described as a suspension of the... Secondary Eliminations Are Disease
However the exact form the chain from irritation or malnutrition to enervation progresses, the ultimate result is an increased level of toxemia, placing an eliminatory burden on the liver and kidneys in excess of their ability. Eventually these orga... Self-consciousness
SELF-CONSCIOUSNESS may be truly defined as a person's inability to get out of his own way. There are, however, some people who are so entirely and absolutely self-conscious that everything they do, even though it may appear spontaneous and i... Self-control
TO most people self-control means the control of appearances and not the control of realities. This is a radical mistake, and must be corrected, if we are to get a clear idea of self-control, and if we are to make a fair start in acquiring i... Sentiment _versus_ Sentimentality
FREEDOM from sentimentality opens the way for true sentiment. An immense amount of time, thought, and nervous force is wasted in sentimentalizing about "being good." With many, the amount of talk about their evils and their desire to overcome them... Shock
The treatment of shock will probably always be unsatisfactory as the cause is so varied, and, although circulatory prostration and vasomotor paresis always constitute the acute condition, the physiologic health of the heart and blood vessels is so v... Signs Of Heart Weakness
It should be remembered that a normal heart may slow to about 60 during sleep, and all nervous acceleration of the pulse may be differentiated during sleep by the fact that if the heart does not markedly slow, there is cardiac weakness or some gener... Simple Dilatation
The term "simple dilatation" may be applied to the dilatation of one or both ventricles when there is no valvular lesion and when the condition may not be called broken compensation. The compensation has been sufficiently discussed. Dilatation of th... Simple Hypertrophy
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... Site Of Lodgement
Almost all foreign bodies are arrested in the cervical esophagus at the level of the superior aperture of the thorax. A physiologic narrowing is present at this level, produced in part by muscular contraction, and mainly by the crowding of the adja... Site Of Lodgment
The majority of foreign bodies in the air passages occur in children. The right bronchus is more frequently invaded than the left because of the following factors: I. Its greater diameter. 2. Its lesser angle of deviation from the tracheal axis. 3. ... Sitz-bath Anchor Of Safety
If there be much delirium, the sitz-bath may be required longer, and the pack shorter, as indicated above (81). In all such cases the packs and sitz-baths, alternately, ought to be continued, till the nervous symptoms disappear altogether, and shoul... Sleep And Rest
Why We Need Rest. A most important element in a life of healthful exercise, study, and play is rest. Even when we are hard at work, we need frequent breathing spells and changes of occupation and amusement to keep one part of our muscles, or our bra... Small Pox - Variola
This disease begins with pain in the head and back, chilly sensations, followed by a high fever, so similar in all respects to a severe attack of Bilious or "winter" fever, that it is difficult or impossible to distinguish it with certainty, as Smal... Small-pox
_Small-pox_, by far the most dangerous of them, has found a barrier in its destructive progress in Dr. Jenner's discovery. Vaccination is an almost sure prophylactic against it; but, notwithstanding, many, with whom the preservative was neglected or... Social/cultural/psychological Obstacles To Fasting
Numerous attitudes make it difficult to fast or to provide moral support to friends or loved ones that are fasting. Many people harbor fears of losing weight because they think that if times were really tough, if there was a famine or they became il... Sore Nipples
This affection of nursing women frequently comes on before the birth of the child, but generally does not make its appearance until after the suckling has continued for a week or more. It seems in some cases to be connected with the aphthae (sore mo... Spasmodic Stenosis Of The Esophagus
Etiology - The functional activity of the esophagus is dependent upon reflex action. The food is propulsed in a peristaltic wave by the same mechanism as, and through an innervation (Auerbach and Meissner plexus) similar to that which controls intes... Spatula-protected Method
Safety-pins in children, point upward, when lodged high in the cervical esophagus may be readily removed with the aid of the laryngoscope, or esophageal speculum. The keeper end is grasped with the alligator forceps, while the spatular tip of the l... Spectacles
If the operator has no refractive error he will need two pairs of plane protective spectacles with very large eyes. If ametropic, corrective lenses are necessary, and duplicate spectacles must be in charge of a nurse. For presbyopia two pairs of spe... Specular Esophagoscopy
Inspection of the hypopharynx and upper esophagus is readily made with the esophageal speculum shown in Fig. 4. High lesions and foreign bodies lodged behind the larynx are thus discovered with ease, and such a condition as a retropharyngeal absces... Spermatorrhea
The points to be gained are, to reduce the action of the amatorial organs of the brain and the secretion of the testes, and to contract and strengthen the tissue of the seminal vesicles and the prostrate gland. Take the B D current. First, treat ... Sponge-pumping
While the usually thin, watery esophageal and gastric secretions, if free from food, are readily aspirated through a drainage canal, the secretions of the bronchi are often thick and mucilaginous and aspirated with difficulty. Further-more, bronchia... Stage 2
Passing the cricopharyngeus is the most difficult part of esophagoscopy, especially if the patient is unanesthetized. Local anesthesia helps little, if at all. The handle of the esophagoscope is still pointing upward and consequently we are sure tha... Stage 3 Passing Through The Thoracic Esophagus
The thoracic esophagus will be seen to expand during inspiration and contract during expiration, due to the change in thoracic pressure. The esophagoscope usually glides easily through the thoracic esophagus if the patient's position is correct. Af... Stage 4 Passing Through The Hiatus Esophageus
When the head is dropped, it must at the same time be moved horizontally to the right in order that the axis of the tube shall correspond to the axis of the lower third of the esophagus, which deviates to the left and turns anteriorly. The head and... Stage I Entering The Right Pyriform Sinus
The operator standing (as in Fig. 66), inserts the esophagoscope along the right side of the tongue as far as and down the posterior pharyngeal wall. A lifting motion imparted to the tip of the esophagoscope by the left thumb will bring the rounded... Starches
Sources of Starch. The starches are valuable and wholesome foods. They form the largest part, both in bulk and in fuel value, of our diet, and have done so ever since man learned how to cultivate the soil and grow crops of grain. The reason is clear... Starvation
It is true that ethical medical doctors use the least-risky procedure they are allowed to use. But this does not mean there are no risks to allopathic treatment. The medical doctor justifies taking the risks by saying that the risk/reward ratio is t... Stings Of Insects
The effect produced by the sting of Bees, Wasps, and Hornets of all kinds, is so nearly, if not quite identical, that I shall make no distinction between them. There are very few, if any persons, who do not know the symptoms, at least the local effe... Stokes Adams Disease Heart Block
Stokes-Adams disease, or the Stokes-Adams syndrome, is a name applied to a combination of symptoms which was described by Stokes in 1846, and had been observed by Adams in 1827. The disease is characterized by bradycardia and cerebral attacks, eithe... Stokes Adams Treatment
The treatment of true Stokes-Adams disease is unsuccessful. If general arteriosclerosis is present, that condition should be treated. Digitalis would seem almost invariably contraindicated, although it is of value in extrasystoles without heartblock... Strabismus Discordance Of The Eyes
If neither of the rectus muscles have been cut and cicatrized, and if the deformity be not congenital, it may ordinarily be cured. Take B D current, with small pointed electrodes. If the eye be turned inward, insert P. P. in the outer angle of the... Strychnin
The question of the advisability of strychnin is a constant subject for discussion. Strychnin is overused in the cases of most patients who are seriously ill. In a patient in whom we are trying to cause nervous and muscular rest, strychnin is certai... Styptic Charms
Fancy can save or kill; it hath closed up wounds, when the balsam could not, and without the aid of salves, to think hath been a cure. CARTWRIGHT. With bandage firm Ulyss... Sudden Invasion Of The Nervous Centres
Of the different forms of scarlatina maligna the most dangerous is the sudden invasion of the nervous system, particularly the _brain_, the _cerebellum_ and the _spine_, by which the patient's life is sometimes extinguished in a few hours. In other ... Sugars
Where Sugar is Obtained. The other great member of the starch, or carbohydrate, group of foods is sugar. This is a scarcer and more expensive food than starch because, instead of being found in solid masses in grains and roots like starch, it is sca... Suggestions For The Control Of Athletics
1. Gymnasiums and athletic grounds in connection with all colleges, preparatory schools, seminaries and high schools are essential, and they should be added to grammar schools whenever possible. 2. Physical training and athletic games, and perhaps... Suppression Of The Menses Amenorrhoea
For sudden suppression from taking cold, as by wetting the feet, there being headache, more or less fever, the pulse frequent and variable, pains in the small of the back and cramp like pains in the pelvic region, give, in alternation, _Aconite_ a... Sympathy
SYMPATHY, in its best sense, is the ability to take another's point of view. Not to mourn because he mourns; not to feel injured because he feels injured. There are times when we cannot agree with a friend in the necessity for mourning or feeling in... Symptomatology And Diagnosis Of Foreign Bodies In The Air And Food Passages
Initial symptoms are choking, gagging, coughing, and wheezing, often followed by a symptomless interval. The foreign body may be in the larynx, trachea, bronchi, nasal chambers, nasopharynx, fauces, tonsil, pharynx, hypopharynx, esophagus, stomach, ... Symptomatology And Treatment Of Chronic Valvular Lesions
Before discussing the treatment of broken compensation in general, it may be well to describe briefly the differences in the symptoms and treatment of the various valvular lesions. ... Symptoms
In hypertension, as long as the heart, which is probably hypertrophied, remains perfectly competent, there are few symptoms, and the person does not seek advice until he notices one or more of several possible conditions. He may be dizzy, his head m...