Coronary Sclerosis Symptoms

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

(Page 13 of 21)

The symptoms are increased tension, which means, sooner or later, hypertrophy of the left ventricle and an accentuated closure of the aortic valve. This alone means more and more tendency to aortic irritation and aortic valve irritation, with inflammation, and later deposits of calcareous material, perhaps with stiffening of the aortic valve and narrowing, aortic stenosis being the result. If such a patient with the disease advanced to this stage must overwork, or sustains any severe muscle strain, an aneurysm of the aorta may occur. In the meantime, with the advancing degeneration of the cerebral arteries, some sudden cerebral congestion, caused by leaning over, lifting, vomiting or hard coughing, may rupture a cerebral vessel, and all the symptoms of apoplexy are present. If small hemorrhages occur in the arterioles of the extremities, of course the prognosis is not serious. Sometimes some of the smaller vessels of the brain may become obstructed and cerebral degeneration occur. If distal vessels become obstructed, as of the toes or feet, gangrene takes place unless the obstruction occurs at a place where the collateral circulation could save the part from such a death. These are some of the ultimate results of serious and final arteriosclerosis. The more frequent result, when the disease has not advanced so far, is a failing heart, either from degenerative myocarditis, coronary sclerosis or dilatation, with all the symptoms of coronary sclerosis and angina pectoris, or with the symptoms of failing circulation.

With high blood pressure to the point of beginning endarteritis, a gradually increasing force of the apex beat occurs, the aortic closure is accentuated as just described, the pulse is slow, the tensity of the arteries depends on the stage of the disease, and when the disease is actually present, the palpable arteries do not collapse on pressure. They soon lose their elasticity, and if this occurs in parts which are soft and flexible, the arteries become more or less tortuous by the force of the blood current twisting and bending them, owing to the irregularity of their hardening. The extremities readily become numb, or the part "goes to sleep," as it is termed. This occurs frequently at night. Sooner or later some edema of the feet and legs occurs in the latter part of the day. Sometimes abdominal colic attacks occur, caused by disturbed circulation. Various disturbances of metabolism may occur, depending on the circulation in the different organs or on coincident disease, and the liver, pancreas and kidneys may be affected.

The blood pressure, if taken in the arms especially, may appear excessively high, but really the actual pressure in the blood vessels may be low. This is on account of the inability to compress the hardened arteries. A heart may be weak and actually need strengthening even while the blood pressure reading is high.

The treatment of this disease is successful only in its prevention, and consists in treatment of hypertension before arteriosclerosis is present. When the disease is actually present, there is nothing to do except for the patient to stop active labor, never to overeat or overdrink, to prevent, if possible, toxemias from the bowels, to keep the colon as clean as possible, and for the physician to give the heart such medicinal aids as seem needed, vasodilators if the heart is acting too strongly, possibly small doses of cardiac tonics if the heart is acting weakly; always with the knowledge that a degenerative myocarditis may be present in considerable amount, or that coronary sclerosis may be present.

As stated above, coronary sclerosis probably seldom occurs without more general arteriosclerosis. Obstruction of the coronary arteries, however, not infrequently occurs at their orifices in conjunction with sclerosis of that region of the aorta and of the aortic valve. The more these arteries are diseased and the more they are obstructed, the more the myocardium of the heart becomes degenerated, softened and weakened, when dilatation of the ventricles, especially the left, is liable to occur. Sooner or later such a condition will cause attacks of angina pectoris and more or less pronounced symptoms of chronic myocarditis and fatty degeneration, as previously described.

Treatment

The treatment of a suspected coronary sclerosis is the same as that of general arteriosclerosis - primarily the elimination of anything which tends to cause high tension or to produce chronic endarteritis. When either general or local arteriosclerosis is present, the treatment which should be inaugurated comprises anything which would tend to inhibit the endarteritis and the classification - necessary periods of rest, the interdiction of all physical effort or physical strain, and the regulation of the diet, digestion and elimination. Perhaps there is no greater preventive of the advance of this disease than a diet considerably less than would be suitable for the same person when in perfect health and at his regular work. The amount of protein especially should be reduced, and the meal hours should be regular. Ordinarily all tea, coffee and tobacco should be forbidden, and alcohol should be allowed only to the aged, if allowed at all.

It has long been considered that iodin would inhibit abnormal connective tissue growth. Iodin most readily reaches the blood as sodium or potassium iodid. Large amounts of iodin are not needed to saturate the requirements of the system for iodin, from 0.1 to 0.2 gm. (1 1/2 to 3 grains) preferably of sodium iodid, twice a day, after meals given with plenty of water, being sufficient; but it should be continued in one or two doses a day not only for weeks, but for months. Whether this iodid or iodin acts per se, or acts by stimulating the thyroid gland to increased activity and therefore to more normal activity, so that it is the thyroid secretion which is of benefit, it is difficult to decide. In view of the fact that in advanced years the thyroid is always subsecreting, and after the very diseases which cause arteriosclerosis or during the diseases which cause arterinsclernsis the thyroid is generally subsecreting, it would appear that the value of iodin is in its effect in stimulating the thyroid gland.

If a small amount of thyroid secretion is evidenced by other symptoms, thyroid extract should be given. The dose need not be large, and should be small, but should be given for a considerable length of time. If the patient seems to be improving on small doses of iodid, however, and the thyroid is supposed not to be very deficient, it is better not to administer thyroid extract, unless the patient is obese.

A serum treatment given intravenously, hypodermically, by the mouth, and by the rectum was inaugurated some years ago (1901 and 1902). and is known as the "Trunecek serum." This first consisted of sodium sulphate, sodium chlorid, sodium phosphate, sodium bicarbonate and potassium sulphate in water in such amounts as to stimulate the blood plasma. Later small amounts of calcium and magnesium phosphate were added to the solution to be injected. These injections seemed to lower the blood pressure, but it is doubtful whether they have any greater ability than a proper regulation of the diet to inhibit arteriosclerosis. At any rate, these injections are but seldom used.

An important means of inhibiting disturbance from any arteriosclerosis which should be employed when possible is the climate treatment. Warm, equable climates, in which there are no sudden radical changes, are advantageous when coronary sclerosis is suspected, and warm climates are valuable in promoting the peripheral circulation and lowering the blood pressure in arteriosclerosis. These patients always require more heat than normal persons, always feel the cold severely, and their hearts always have much less disturbance, fewer irregularities and fewer attacks of pain during warm weather than during cold weather.

Simple hydrotherapeutic measures are also necessary for these patients, but baths should not be used to the point of causing debility and prostration. Applications of cold water in any form are generally inadvisable. Very hot baths are also inadvisable; but pleasantly warm baths, taken at such frequency as found to be of benefit to the individual, relax the peripheral circulation relieve the tension of the internal vessels, lessen the work of the heart, and promote healthy secretion of the skin, the skin of arteriosclerotic patients often being dry. This dry skin is especially frequent if there is any kidney insufficiency, which so soon and so readily becomes a part of the arteriosclerotic process.

If the patient is old, small doses of alcohol may act physiologically for good. In these arteriosclerotic patients the activities of alcohol should be considered from the drug point of view, not from that of all intoxicating beverage. Other drugs are considered in the discussion of hypertension.

If the heart actually fails, the treatment becomes that of chronic myocarditis and of dilatation.

Not infrequently in sclerosis of the arteries, especially of the coronary arteries, the blood pressure is not high, but low, and the heart is insufficient. In such patients cardiac tonics may be considered, but they must be used with great care. Digitalis may be needed, but it should be tried in small doses. It often makes a heart with arteriosclerosis have severe anginal attacks. On the other hand, if the heart pangs or heart aches and the sluggish circulation are due to myocardial weakness without much actual degeneration, digitalis may be of marked benefit. The value of digitalis in doubtful instances will be evidenced by an improved circulation in the extremities, a feeling of general warmth instead of chilliness and cold, an increased output of urine, and less breathlessness on slight exertion.