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Updated: May 11, 2025
Acute endocarditis can probably not occur without some inyocarditis, and myocarditis probably does not occur without some endocardial disturbance and perhaps some pericardial irritation. This is especially true in endocarditis which occurs during any acute infection, even in rheumatism. The greater the amount of pericarditis, the more serious is the acute condition.
The autopsy showed little save chronic myocarditis with brown atrophy, calcification of part of thyroid, non-united fracture of neck of left femur, moderate coronary arteriosclerosis. "Acute mania." Death from bilateral phthisis with numerous cavities and bilateral pleuritis.
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 too speedy return to activity. The convalescence must be prolonged until the heart is able to sustain the work required of it. The treatment of gradual dilatation in acute disease has been sufficiently discussed under the subject of acute myocarditis.
More and more exercise, sweatings from Turkish baths, electric-light baths, body baking, vigorous massage and more or less purging are all valuable. Anything which reduces the general weight will help the heart. The prognosis is often good. It should be understood that especially in acute conditions a positive separation of endocarditis from myocarditis is incorrect.
For the sake of discussing the therapy of cardiac disturbances in a logical sequence, they may be classified as follows: Pericarditis Acute Adherent Myocarditis Acute Chronic Fatty
When the heart begins to fail from a gradually progressing myocarditis, the pulse rate generally increases, especially on the least exertion, and on fast walking may be as high as 120 or 130 a minute, or even higher. It may be found near 100 on the least exertion, even after some minutes of rest. These patients must have more or less absolute bed rest.
After a period which may be termed the normal period of hypertension in normal life, as age advances the systolic tension may lower, provided there is no kidney lesion. This is due to the slowly developing chronic myocarditis and a lessening of the tension and therefore lessening of the resistance to the heart. This may be nature's method of lengthening the life of the individual.
Like any other muscular tissue, the heart hypertrophies when it has more work to do, provided this work is gradually increased and the heart is not strained by sudden exertion. To hypertrophy properly the heart must go into training. This training is necessary in valvular lesions after acute endocarditis or myocarditis, and is the reason that the return to work must be so carefully graduated.
The greater the amount of myocarditis, the more doubtful is the heart strength in the near future. The greater the amount of endocarditis, the greater the doubt of freedom from future permanent valvular lesions. This inflammation of the endocardium is generally confined to the region of the valves, and the valves most frequently so inflamed are the mitral and aortic.
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