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Updated: May 11, 2025
If a child has had an attack of heart inflammation, a myocarditis or an endocarditis, greater care should be taken of him not only when he is well but especially when he becomes ill of any other disease.
Subsequent movements of the bowels should be daily obtained by vegetable laxatives with occasional enemas, as needed. With all inflammation of the heart and the possibility of myocarditis developing or being actually present, it is not advisable to use salines freely or often. Whether any drug should be used which acts directly on the heart is often a question for decision.
The more frequent result, when the disease has not advanced so far, is a failing heart, either from degenerative myocarditis, coronary sclerosis or dilatation, with all the symptoms of coronary sclerosis and angina pectoris, or with the symptoms of failing circulation.
The left ventricle should not be forced to act too sturdily against this aortic resistance. Consequently the dose of digitalis must be small. On the other hand, it frequently happens, especially in old age, that myocarditis or fatty degeneration has already occurred before this cardiac weakness develops in the presence of aortic narrowing, and digitalis may not be indicated at all.
As long as the circulation in the heart itself is good and not impaired by coronary sclerosis, and as long as this slowly developing chronic myocarditis has not advanced far, cardiac symptoms will not be in evidence; but if these conditions occur, or if the blood pressure is so greatly increased as to damage the aortic valve or strain and dilate the left ventricle, symptoms rapidly appear, and the heart must be carefully watched.
Probably often a myocarditis and perhaps some fatty degeneration are at the base of such a slowed heart after serious infections. A heart which has not always been slow but has gradually become slow with the progress of hypertension and arteriosclerosis will often disclose on postmortem examination serious lesions of the coronary arteries.
Chronic lead poisoning causes a slow pulse on account of the increased blood pressure. A slow pulse may occur during convalescence from acute infections, such as typhoid fever and pneumonia, and sometimes after septic processes. While it may not be serious in these conditions, it should always be carefully watched, as it may show a serious myocarditis.
The acute symptoms being over, a careful analysis of the probable cause of the anginal attack should be made. If it is a general sclerosis, the treatment should be directed to that condition. If it is a myocarditis, a fatty degeneration of the heart or a fatty heart, this should be properly treated as previously described.
More or less acute dilatation occurring in such persons is likely to recur on the least exertion, unless the patient takes a prolonged rest cure and the heart is so well that it recuperates perfectly. Any chronic myocarditis, however, may prevent such a heart from ever being as perfect as it was before.
Acute dilatation is not an infrequent cause of death during ordinary labor, and is more apt to occur in these cardiac patients. Septic infections after parturition are prone to cause endocarditis and myocarditis, and a malignant endocarditis may develop from uterine infection or uterine putridity.
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