Chronic Myocarditis; Fibrous

Disturbances of the Heart
by Oliver T. Osborne, M.D.

(Page 7 of 18)

Chronic myocarditis may develop on an acute myocarditis, but is generally a slowly progressive chronic process from the beginning; it occurs mostly in persons past middle life, and as a rule is not primarily associated with rheumatism or valvular disease of the heart. Perhaps generally the term "chronic myocarditis" is incorrect, as a real inflammatory condition is not present and has not been present; it is really a degenerative process with the development of connective tissue, a fibrosis and more or less hardening of the arterioles, a cardiosclerosis. In many instances this fibrosis is associated with fat deposits or fatty degeneration. The disease is often caused by a narrowing or obstruction or calcareous degeneration of the coronary arteries, thus diminishing the blood supply to the heart muscle. This chronic myocardial degeneration is often a part of the general arteriosclerosis, and is an important factor in what is termed cardiovascular-renal disease. In simple chronic renal diseases the heart first normally hypertrophies to overcome the increased blood tension and increased resistance.

The principal causes of this degeneration are normal old age, or premature age caused by various conditions. In other words, anything which hastens arteriosclerosis will cause myocardial degeneration. The causes recognized as most frequently producing this condition are syphilis; gout; repeated attacks of rheumatism; excess in the use of alcohol (meaning repeated daily too large amounts, as well as actual dipsomania); the overuse of tobacco; excess in drinking tea or coffee; general overeating, and excessive eating of meat in particular, if the organs of elimination do not work perfectly and if such eating causes or allows putrefactive changes in the intestines; and progressive, prolonged wasting diseases, such as tuberculosis and cancer. It has also seemed in some cases that the only cause was excessive, hard physical labor, including excessive athletic work, and in other cases that prolonged anxiety and worry have been causes of cardiac degeneration and actual cardiac failure. Prolonged absorption of toxins from mouth and tonsil infections may be a not infrequent cause.

These myocardial changes are sometimes associated with chronic pericarditis and chronic endocarditis, and may accompany or follow valvular disease of the heart. Failure of compensation in valvular disease and dilatation of the heart are sequences which occur sooner or later.

Symptoms and Signs

The symptoms of chronic myocardial degeneration are progressive weakness, slight at first, noticeable on exertion (and what was not considered exertion becomes such), as evidenced by slight palpitation, slight shortness of breath, leg weariness and mental tire. The heart frequently becomes more rapid, not only with exertion and change of position to the erect, but even after eating. Slight cardiac stimulants, as coffee, affect the heart more than previously; there is some sleeplessness, more or less troublesome, and more or less indigestion. There may be mental irritability and some mental deterioration, as shown in various ways. There are likely to be slight edemas of the lower extremities toward night. The amount of urine may diminish. A previously high blood pressure becomes lower. The pulse may be occasionally intermittent, and later actually irregular.

The physical signs often show an enlargement of the heart, with increased activity at first, from irritability of the heart and a lack of perfect coordination; later the heart may show typical signs of weakness. Not infrequently a heart suffering from fibrosis acts perfectly until some sudden exertion, as lifting, running or serious illness causes it suddenly to become weak. Such a heart rarely regains its former strength. This occurs frequently to those who have supposed themselves to be in perfect physical health. Some sudden strain which they have previously been able to endure without injury, such as carrying a weight upstairs, cranking a refractory engine, pumping up a series of tires, or walking rapidly with a younger or more active companion, will suddenly give cardiac distress signals, serious exhaustion and more or less lengthy prostration, perhaps for an hour or so, or perhaps for several days. Permanent cardiac weakness may follow, or compensation may again occur, to be more easily broken later. Slight cardiac pains and sensations referred to the cardiac region become frequent. Disliking to lie on the left side, when previously the patient has been able to sleep on this side without discomfort, is an evidence of cardiac disturbance. There may be no real pains, but the patient becomes conscious of his heart, perhaps for the first time in his life. This alone is an indication of coming trouble.

If these signs and symptoms develop late in life, or at any age with other symptoms of sclerosis or senility, little can be done therapeutically except to afford temporary relief and to prevent the occurrence of acute attacks of cardiac distress or dyspnea. If the disturbance is really due to chronic cardiac degeneration, the sooner the patient learns that his ability is restricted, that his life is narrowed, the better for his future.