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Updated: May 11, 2025
Sudden rising, sudden erect posture, the exertion of walking too early, going up stairs too early or taking moderate, and later severe exercise too early, may cause dilatation of the heart muscle that has become weakened by acute myocarditis.
The left ventricle may, however, become weakened, either by some sudden strain or by a chronic myocarditis, and relative insufficiency of the mitral valve may occur. The subsequent symptoms are typically those of loss of compensation.
It is probably rare when acute endocarditis occurs that more or less myocarditis is not present.
If the heart is normal the ventricles should hypertrophy with the increased work that they are under; and the blood pressure could increase for this reason. Later in exophthalmic goiter the heart muscle may become degenerated, a chronic myocarditis, and the ventricles may slightly dilate. At this time the blood pressure is lowered.
Chronic myocarditis may develop on an acute myocarditis, but is generally a slowly progressive chronic process from the beginning; it occurs mostly in persons past middle life, and as a rule is not primarily associated with rheumatism or valvular disease of the heart.
If acute myocarditis is believed or known to be present, cardiac tonics such as digitalis should not be given; large doses of strychnin should not be given; vasocontractors such as ergot should not be given; large amounts of food or large bulks of liquid should not be taken into the stomach at one time; in fact, unless there is some special indication, the twenty-four hour amount of fluid should be diminished.
The prolonged high temperature causes the heart to beat more rapidly, while the toxins produced by the fever process cause muscle degeneration of the heart or a myocarditis, and at the same time the nutrition of the heart becomes impaired either by improper feeding or by the imperfect metabolism of the food given; hence the heart muscle becomes weakened, and cardiac failure or cardiac relaxation or dilatation occurs.
Whether an albuminous or parenchymatous degeneration of the muscle fibers or a fatty degeneration occurs, whether there is a real myocarditis that always precedes the dilatation, or whether the weakening and loss of muscle fibers or a diminished power of the muscle fibers occurs without inflammation, dilatation of the heart is always a factor to be considered, and frequently occurs in acute disease.
It is often difficult to decide when acute endocarditis has developed; but with the knowledge that the endocardium often becomes inflamed during almost any of the acute infections, the physician should repeatedly examine the heart for murmurs, for muffled closure of the valves, or for other evidences of endocarditis or myocarditis during the acute infective process.
When there are evidences of chronic myocarditis or a history of broken compensation and the borderline of compensation and dilatation is very narrow, or when there is arteriosclerosis, the danger from an anesthetic and an operation is much greater; it may be serious, in fact, and the decision must be made whether or not the operation is absolutely necessary.
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