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Updated: June 1, 2025
While the continued use of alcohol may not cause arteriosclerosis directly, it can cause such impaired digestion of foods in the stomach and intestine, and such impaired activity of the glands, especially the liver, that toxins from imperfect digestion and from waste products are more readily produced and absorbed, and these are believed by some directly or indirectly to cause cardiovascular- renal disease.
While this disease almost invariably has a pathology, cases have occurred in which no lesion of the heart could be found, but it generally occurs coincidently with arteriosclerosis, in which the coronary arteries are more or less involved and the arterial system of the brain may be diseased. It occurs more frequently in men than in women, and in them mostly after middle, or in advanced, life.
Generally, however, if a heart with aortic stenosis needs stimulation, the blood pressure is generally none too high, although there may be arteriosclerosis present. Therefore when nitroglycerin is indicated to lower blood pressure, digitalis is not usually indicated; when digitalis is indicated to aid the heart, nitroglycerin is generally not indicated.
In simple chronic renal diseases the heart first normally hypertrophies to overcome the increased blood tension and increased resistance. The principal causes of this degeneration are normal old age, or premature age caused by various conditions. In other words, anything which hastens arteriosclerosis will cause myocardial degeneration.
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.
I shall not give any other points in the history except that this paralysis was of four months' duration, there was some resistance to movements at the elbow and knee, but Babinski and other indications of a central organic lesion were absent. The results of the rest of the physical examination need not be mentioned except that the patient presented evidences of arteriosclerosis.
The disease is often caused by a narrowing or obstruction or calcareous degeneration of the coronary arteries, thus diminishing the blood supply to the heart muscle. This chronic myocardial degeneration is often a part of the general arteriosclerosis, and is an important factor in what is termed cardiovascular-renal disease.
As stated above, coronary sclerosis probably seldom occurs without more general arteriosclerosis. Obstruction of the coronary arteries, however, not infrequently occurs at their orifices in conjunction with sclerosis of that region of the aorta and of the aortic valve.
The treatment of this disease is successful only in its prevention, and consists in treatment of hypertension before arteriosclerosis is present.
This feature of digitalis action in arteriosclerosis renders its use sometimes a question of careful decision. The dose of digitalis under such a condition should not be large. It may be indicated, however, and may do a great deal of good, and it does not always increase the blood pressure.
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