Simple Dilatation

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

(Page 17 of 20)

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 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.