Primary or First Causes.--They refer in this disease to a peculiar const.i.tution. Children that have a tuberculous const.i.tution are more liable to this disease. Acute rheumatism or tonsilitis are the causes and this trouble follows or goes with them. Infectious diseases also cause it.
Symptoms.--Slight pain in the heart region, fever moderate. These subside or effusion may set in and this usually occurs with acute rheumatism, tuberculosis and septicemia. Sometimes these symptoms are absent.
Treatment of Pericarditis.--The patient must rest quietly in bed and a doctor should be in attendance. An ice bag placed over the heart frequently gives relief and quiets the distress and pain. There is apt to be liquid in the sac (pericardium) and to lessen the tendency to this there should not be much drink or liquid food taken. There should be what is called a dry diet. (See Nursing Department for this.)
ENDOCARDITIS.--Inflammation of the lining of the heart chiefly confined to the valves; it may be acute or chronic.
Simple Kind, Cause.--Occurs at all ages, but most often in children and young adults. It most frequently comes with acute rheumatism, ch.o.r.ea, tonsilitis, scarlet fever, and pneumonia. The valves in the left heart are most often affected, the mitral simply swollen or bearing small growths.
Symptoms.--If it is caused by acute rheumatism, there may be higher temperature, without increase of joint symptoms. Heart beats faster and is irregular. It may run into chronic valvular disease.
Treatment of Endocarditis.--Preventive.--Much can be done to prevent this disease by closely watching the patient having the disease that causes it.
The heart should be closely watched. Acute inflammatory rheumatism is a frequent cause and the heart must be watched continually in this disease.
When the patient has this disease he must be quiet and in bed. This is essential. A doctor must be called, for the disease is serious and dangerous.
Diet.--Should be liquid. Milk or preparations made with it is the usual diet. Care must be taken that the stomach and bowels be not disordered.
Gas collecting in the stomach causes much distress to one who has endocarditis or valvular disease.
Caution.--Avoid early exertion after getting well.
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CHRONIC ENDOCARDITIS.--Usually occurs in persons under middle age.
Generally follows acute endocarditis. It may be caused by syphilis, alcoholism, gout, and prolonged over-exertion. The edges of the valve become thickened and then the thickened parts separate and cannot meet exactly and therefore fail to close the opening they are set to guard.
CHRONIC VALVULAR DISEASE.--Results of valve lesions. Narrowing of a valve causes increased difficulty in emptying the chamber of the heart behind it. Insufficiency of a valve allows the return of the blood through the valve during the dilation of a chamber, thus increasing the amount of blood entering the chamber beyond the normal. Either trouble causes dilation of the chamber and compensatory hypertrophy. Enlargement of its wall must take place in order to perform the extra work demanded constantly, for the normal reserve force of the heart muscles can accomplish the extra task only temporarily. This enlargement increases the working power of the heart to above normal, but the organ is relatively less efficient than the normal heart, as its reserve force is less and sudden or unusual exertion may cause disturbance or failure of the compensation acquired by the enlargement. If this loss of reserve force is temporary, compensation is restored by further enlargement and by diminution, by rest, of the work demanded of the heart. Any valvular lesion, whether a stenosis (narrowing) of the outlet or insufficiency from the moment of its origin, leads to certain alterations in the distribution of pressure upon each side of the affected valve. If the body of the heart itself did not possess a series of powerful compensatory aids, that is, the power of making good a defect or loss, or restoring a lost balance, to improve this relation of altered pressure, then every serious lesion at its very beginning would not only cause serious general disturbances of circulation, but very soon prove fatal. Without compensation of the power of making good the defect or loss, the blood in every valvular disease or lesion would be collected behind the diseased valve. The heart"s reserve power prevents to a certain extent such a dangerous condition; the sections of the heart lying behind the diseased valve work harder, diminish the blood stoppage and furnish enough blood to the peripheral arteries. The reserve force is used in stenosis to overcome the obstacle, whereas in insufficiency it must force more blood forward during the succeeding phase through the diseased valve. To effect this increased work permanently, anatomic changes in the heart are bound to follow. The changes consist in hypertrophy (enlargement of the heart muscle) and dilatation of the different chambers. Under this head, compensation, is included the increased filling and increased work of certain heart chambers with their resulting dilatation and hypertrophy. But this compensation cannot last forever. It fails sometimes and certain symptoms follow as hereafter related. Therefore persons who have valvular disease and who have been informed that the heart has adapted itself to the condition by enlarging of its walls and chambers and thus forming the condition called compensation, should be very careful of their mode of living and not put any undue or sudden strain upon the heart that might destroy the conditions that make compensation continue. In the following pages symptoms are given showing what happens when compensation continues and when it fails.
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AORTIC INSUFFICIENCY OR INCOMPETENCY.--The valves are not doing their work thoroughly.
Symptoms.--They are often long absent; headache, dizziness, faintness, flashes of light, difficult breathing, and palpitation on exertion, and pain in the heart region may occur early. The pain may be dull and localized, or sharp and radiating to the neck or left arm. When compensation fails, we have difficult breathing, which is worse at night, swelling of the eyes and feet, cough, anemia. Sudden death is more common in this than with any other valvular disease. You can hear a soft blowing sound by listening with your ear.
NARROWING (Aortic Stenosis).--Caused by chronic endocarditis, etc. Their valve segments are usually adherent to each other by their margins and are thickened and distorted.
Symptoms.--When compensation is gone, diminished blood in the brain causes dizziness and faintness.
MITRAL INSUFFICIENCY OR INCOMPETENCY.--This is the most common valvular disease. The segments of the valve may be shortened and deformed. There is often stenosis (narrowing) caused by this deformity. The effects are regurgitation, flowing back of blood from the left ventricle into the left auricle, which is also receiving blood from the lungs, causing dilatation of the auricle and its enlargement to expel the extra blood; dilatation and other enlargement of the left ventricle occurs on account of the large quant.i.ty of blood forced in by the auricle; obstruction to flow of blood from pulmonary veins due to extra blood in left auricle, hence dilatation and enlargement of right ventricle which forces blood through the lungs; dilatation and enlargement of right auricle.
Symptoms.--If compensation is slightly disturbed we have blueness (cyanosis), clubbing of the fingers, hard breathing on exertion, and attacks of bronchitis and bleeding from the lungs. If compensation is seriously disturbed we are likely to have the blueness (cyanosis) more marked, heart beat feeble and irregular, constant hard breathing, with cough and water or b.l.o.o.d.y sputum, dropsy in the feet first and going up and involving the abdomen and chest cavities.
MITRAL STENOSIS.--This is the narrowing of the valve opening. It is most common in young persons, chiefly females. The narrowing of the valve opening may be due to thickening or hardening of the valve segments, adhesion of their edges, thickening and contraction of the tendinous cords of the valve ring.
Symptoms.--Similar to mitral insufficiency, but they develop slower and those symptoms of venous congestion of the lungs, liver, etc., are more marked; bleeding from the lungs is more common.
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TRICUSPID (VALVE) INSUFFICIENCY.--Cause.--Usually due to dilatation of the right ventricle in mitral disease or with lung emphysema or other obstruction to the lungs" circulation.
TRICUSPID STENOSIS (NARROWING).--Rare except in cases from the time of birth.
Recovery from the valvular disease, depends upon the degree of compensation maintained and is best when this is acquired spontaneously.
This is to be judged by the heart action. The prognosis is poor in children. It is better in women than in men.
Treatment (a) While Compensated.--Medicine is not necessary at this period. The patient should lead a quiet, regulated, orderly life, free from excitement and worry; and the risk of certain death makes it necessary that those suffering from a disease of the aorta should be especially warned against over-exertion and hurry. An ordinary healthy diet in moderate quant.i.ties should be taken, tobacco and stimulants not allowed at all.
The feelings of the patient must control the amount of exercise; so long as no heart distress or palpitation follows, moderate exercise will be of great help. A daily bath is good. No hot baths should be taken and a Turkish bath absolutely prohibited. For the full-blooded, fleshy patient an occasional dose of salts should be taken. Patients with a valvular trouble should not go into any very high alt.i.tudes; over-exertion, mental worry and poor digestion are harmful.
(b) The stage of broken compensation. Rest. Disturbed compensation may be completely restored by rest of the body. In many cases with swelling of the ankles, moderate dilatation of the heart and irregularity of the pulse, the rest in bed, a few doses of the compound tincture of cardamon and a saline purge suffice within a week or ten days to restore the compensation. For medicine a doctor must be consulted as each individual case must be treated according to its peculiar symptoms.
FATTY HEART.--This occurs often in old age, prolonged, infectious, wasting disease, anemia, alcoholism, poisoning by phosphorus and a.r.s.enic.
ANGINA PECTORIS.--True angina, which is a rare disease, is characterized by paroxysms of agonizing pain in the region of the heart, extending into the arms and neck. In violent attacks there is the sensation of impending death. Usually during the exertion and excitement, sudden onset of agonizing pain in the region of the heart and a sense of constriction, as if the heart had been seized in a vise. The pains radiate up the neck and down the arm. The fingers may be numb. The patient remains motionless and silent, the face usually pale or ashy with profuse perspiration. Lasts for several seconds or a minute or two.
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Treatment.--Live an absolutely quiet life, avoid excitement and sudden muscular exertion. During the attack, break a pearl of amylnitrite in a handkerchief and inhale the fumes. These should always be carried. If no relief is had in a minute or two chloroform should be given at once. It is dangerous and you must look to your physician for advice and treatment.
ARTERIOSCLEROSIS.--A localized or diffused thickness of the inner coat and then of the other coats of the arteries. Arteries look lumpy and are crooked, dilated with stiff, thin or calcified walls. All coats, especially the middle, show degeneration. It usually comes in later life.
Treatment.--Regulate the mode of life, avoid alcohol, excess of eating, drinking, exertion, excitement and worry. Keep the bowels and kidneys acting regularly. There is no medicine for it.
ANEURISM.--This is a local dilatation of an artery. A local tumor.
Treatment.--Absolute rest, restrict fluids. There is always danger from rupture.
MYOCARDITIS.--This is an inflammation of the muscle substance of the heart. It may be acute or chronic.
Causes.--Endocarditis and pericarditis in the course of rheumatism; acute fevers like typhoid, etc.; clots lodging in the heart arteries, coming from diseases such as septicemia and pyemia.