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Organic Disease of the Heart.
Though the symptoms vary in detail according to the valves affected, yet certain general symptoms are generally found in all cases; among the first of these is shortness of breath. The patient first observes that he cannot take exercise with the same freedom of breathing as before ; and he usually observes that he cannot even walk up stairs without a feeling of oppression in the chest or even of suffocation. Such effort, too, is accompanied by a some what violent action of the heart, which the patient probably describes as " palpitation." If persisted in, such exercise causes a feeling of faintness. After a time this shortness of breath, which was at first felt only upon exercise, becomes habitual; so that the ordinary duties of life occasion extreme inconvenience. This diffi culty in breathing is usually accompanied by a cough and some little expectoration; at times this expectoration is streaked with blood. There is not usually any considerable pain, but simply a feeling of distress in the chest, often accompanied by a state of mental anxiety and depression quite out of proportion to the apparent physical derangement. The sleep, too, is often disturbed by unpleasant dreams, in which the patient fancies himself exposed to danger and death.
There is apt to be a blueness of the skin, indicating impaired circulation of the blood. All these symptoms become exaggerated with the lapse of time, until the heart meets the increased demand upon its strength by an increase in size. For just as a man's arm becomes thicker and stronger after long continued use of a sledge hammer, so the heart increases in size, in order to accomplish the severer task imposed upon it by the failure of the valves. Hence it happens that the subjects of organic disease of the heart usually exhibit, sooner or later, an enlargement of the heart. This en largement is not to be regarded as a disease in itself, but is merely the result of the previous disease of the valves. The enlargement is in fact a beneficial change, as is indicated by the improvement which takes place in the patient's symptoms. It is not uncommon to find individuals with organic heart disease who enjoy, neverthe less, excellent health, because the heart is sufficiently powerful to circulate the blood properly, notwithstanding the impediment in the valves.
But sooner or later the heart becomes unequal to the ever- increasing resistance, and the original symptoms return with even greater intensity. There now occurs, if it has not previously taken place, swelling of the body, usually beginning in the feet and legs, and spreading over the entire trunk. At the very beginning, this dropsy is noticed in the feet only toward the close of the day, and has disappeared when the patient rises in the morning. But it finally becomes persistent, and occasions the patient a great deal of annoyance. The face becomes swollen and livid, there is often so much liquid in the chest cavities as to seriously impair the breathing; the abdomen, too, becomes distended with fluid, and the feet and legs acquire such a size that the skin seems to be on the point of bursting. When the disease has progressed so far as this, the patient is often unable to maintain the recumbent posture with comfort; he is compelled to sleep in a chair or bolstered up in bed. The sluggishness of the circulation impairs also the func tions of most of the organs; the stomach and intestines fail to perform their work in the usual way ; the appetite and digestion become impaired, and there is often obstinate diarrhea. The patient is also often frequently troubled with piles.
Organic disease of the heart may remain for a long time harm less; indeed, examiners for life insurance companies not infrequently find such diseases in individuals who had never been led to suspect the existence of serious disease of the heart or elsewhere. Indeed after the disease has been discovered, and the patient is even suffer ing from the lighter symptoms, many years may elapse without the occurrence of serious interference with the health ; many indi viduals afflicted in this way live to a good old age, and ultimately die of affections in no way attributable to the heart disease. So soon, however, as enlargement begins, it is to be expected that sooner or later - in the course of many years perhaps - the severe symptoms will follow ; and there is always a possibility that a fatal result may occur suddenly, either from apoplexy in the way already described, or from paralysis of the heart.
Treatment.-Until the symptoms indicate an impairment of function of various organs, - shortness of breath, etc. - organic disease of the heart frequently requires no treatment. Indeed, in many cases, it is advisable that the fact of the disease should be concealed from the patient if possible, as is often the case when the discovery be made accidently by a physician; for an individual conscious that he is suffering from" heart disease," is apt to regard himself as an invalid and to adopt a mode of life which will render his general health delicate, and will thus favor the development of the disease in the heart. Such an individual should place himself under the best possible conditions for the maintenance of health, including a fair amount of exercise in the open air ; and it is just this latter point from which he will shrink if he be aware of the existence of heart disease. Yet it is advisable that such patients should avoid those influences which can exert a sudden strain upon the heart and thus tend to increase the difficulty; he should, there fore, abstain from very violent physical exertion, from excessive mental emotion, and from the use of alcoholic stimulants. Yet if he bear this general principle in mind, it is far better that he do not attempt to regulate his life by any set of rules, but merely observe the general facts of hygiene, by keeping himself well fed, well clothed and in good exercise.
After the symptoms begin to indicate that the heart is no longer equal to the demand made upon it, that the circulation is becoming feeble, much can be done to retard the progress of the disease and to restore the patient to a fair degree of health by the use of digitalis. The effect of this drug is to stimulate and strengthen the heart's action ; under its use the breathing becomes easier, the skin loses its bluish tinge, and the patient feels much improved. Ten drops of the tincture of digitalis may be admin istered every four hours, in water.
When the disease has advanced to such a stage that general dropsy and the accompanying symptoms are present, but little can be done to materially prolong the patient's life. The dropsy can be, perhaps, diminished by the use of saline laxatives, though the exhaustion consequent upon their use is apt to weaken the patient materially. All the symptoms must be treated as they arise. Death ordinarily occurs after a long period of suffering, though it may happen from sudden distension of the heart, caused by un usual physical effort or mental excitement ; in these cases there is either a paralysis of the heart or a rupture of its walls.
Enlargement of the heart, technically called hypertrophy, may result from several other causes than the one just mentioned. In the majority of cases it is doubtless due to a previous inflammation of the endocardium, as described above; but there are instances in which there have been no endocarditis, and no impairment of the valves. These causes may be located in various parts of the body quite removed from the heart, for since the function of the heart is to propel the blood through the body, any obstacle to the passage of the blood through the vessels will increase the work of the heart, and hence cause it to enlarge. Several of these causes will be discussed under the appropriate headings, such as aneur ism and disease of the kidneys. But one disease will be described in which enlargement of the heart is a prominent symptom ; this is
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