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Raynaud suggested that the local syncope was produced by contraction of the vessels; the asphyxia is probably caused by a dilatation of the capillaries and venules, with persistence of the spasm of the arterioles.
This prolonged rest or diastole of the heart allows the circulation in the coronary arteries to become normal, and the nutrition and muscle tone of the heart improves. Digitalis also increases the blood pressure, not only by improving the activity of the heart, but also by causing some contraction of the arterioles.
Dry cold obtained by means of icebags, or by Leiter's lead tubes through which a continuous stream of ice-cold water is kept flowing, is sometimes soothing to the patient, but when the vessels in the inflamed part are greatly congested its use is attended with considerable risk, as it not only contracts the arterioles supplying the part, but also diminishes the outflow of venous blood, and so may determine gangrene of tissues already devitalised.
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.
The arteries here extend into very small vessels, which are called arterioles, and from these infinitely small vessels spring the equally minute radicals or roots of the veins, which are ultimately to become the great rivers bearing the blood back to the heart. In its passage through this minute circulation the alcohol finds its way to every organ.
Next it seems as if the strongly contracted arterioles begin actually to prevent some of the peripheral circulation, the blood is piled up in the large arteries, and the venous circulation becomes more and more sluggish, while the lips, finger nails and forehead become cyanotic.
The cells are fed and sustained by the circulation of the blood; they are reached from the smaller branching arteries by a network of minute, thread-like channels, sometimes called 'arterioles. These arterioles are accompanied by the equally fine wires of the nervous system, closely connected with the brain centers.
The ligature of the three arteries was quickly accomplished, but the major shook his head, and when the assistant had removed his fingers he examined the stump, murmuring, certain that the patient could not hear as yet: "It looks bad; there's no blood coming from the arterioles."
There are thousands of miles of minute tubing in the human body the arterioles, veins, capillaries and lymphatic vessels.
Perhaps generally the term "chronic myocarditis" is incorrect, as a real inflammatory condition is not present and has not been present; it is really a degenerative process with the development of connective tissue, a fibrosis and more or less hardening of the arterioles, a cardiosclerosis. In many instances this fibrosis is associated with fat deposits or fatty degeneration.
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