United States or Poland ? Vote for the TOP Country of the Week !
The mere determination as to where the apex beat is located, and as to what murmurs may be present is not sufficient; we must attempt to determine the probable condition of the myocardium. Probably most acute infections cause more or less myocarditis, depending on their intensity and their prolongation.
A common characteristic in a large proportion of middle-aged or old patients with heart disease is the presence of degenerative changes in the myocardium, the valves, or the arteries of the heart. In children, on the other hand, the most common disturbances of the heart are acute inflammations affecting its different structures, and due in most instances to acute infections.
Fraenkel found these nodules in the myocardium in a case of chorea, showing the close relationship between it and rheumatism. While repeated careful examination of the heart during acute infections will generally show signs of endocarditis if it is present, even if there are no subjective symptoms, the disease may be so insidious as not to be noted until a valvular lesion occurs.
Comparison of the findings after these two injections will determine which factor, vagal or cardiac tissue, is the greater in the condition present. The patients with a large cardiac factor are the ones who may be more improved by the digitalis treatment than those in whom the fibrillation is caused by vagus disturbance. The prognosis depends on the condition of the myocardium of the vagus.
Therefore when a heart has serious lesions, whether of the myocardium or of the valves, with compensation only sufficient, the action of caffein in any form is contraindicated.
If a pregnant woman is known to have a degenerative condition of the myocardium, or arteriosclerosis, the danger from the pregnancy is serious, and the pregnancy should rarely be allowed to continue. Even if no serious symptoms occur during the term of the pregnancy, and the heart continues to compensate sufficiently for its defect, labor should never be allowed to be prolonged.
If the myocardium is much inflamed at the same time, the heart becomes more rapid and the blood tension lowered, and the apex beat diminished in intensity and perhaps not palpable. If there is pain, with or without pericarditis, it is often referred to the epigastrium, especially in children. The patient is often nervous, restless and sleepless. In simple endocarditis emboli rarely occur.
The treatment is aimed at chronic heart disease, to develop a greater cardiac reserve strength; the whole object of the treatment is to strengthen the myocardium, either in conditions of its debility or in conditions of diminished compensation in valvular disease.
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.
Such an operation would be indicated when the apex is fixed so that there is a constant sensation of hugging of the heart at the fourth and fifth ribs, with paroxysms of pain and cardiac weakness. While the myocardium is the most important muscle structure of the body, it has but recently been studied carefully or well understood clinically or pathologically.
Word Of The Day