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Sometimes with serious edema and after serious hemorrhage the heart becomes very slow, unless some exertion is made, when it will beat more rapidly than normal. This probably represents a diminished cardiac nutrition. The cardiac lesions which cause a pulse to be slow are sclerosis or thrombosis of the coronary arteries, fatty degeneration of the myocardium, and Stokes-Adams disease.
Personally I think it was a very healthy way, and I believe it will be for the good of the race when women are made to exercise more. But Hilaria had the seeds of this sclerosis in her then, and nothing can stop it; over-exertion may have made it worse, as it does any illness, but it couldn't have caused it. It's being mercifully rapid, that's one comfort."
Before the administration the patient must be overhauled; its administration is contra-indicated in the presence of disease of the heart and blood vessels, especially a combination of syphilitic aortitis and sclerosis of the coronary arteries, with degeneration of the heart muscle; in affections of the central nervous system, especially advanced paralysis, and in such disturbances of metabolism as are associated with diabetes and Bright's disease.
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.
Sooner or later such a condition will cause attacks of angina pectoris and more or less pronounced symptoms of chronic myocarditis and fatty degeneration, as previously described. The treatment of a suspected coronary sclerosis is the same as that of general arteriosclerosis primarily the elimination of anything which tends to cause high tension or to produce chronic endarteritis.
In the first stage the arteries are healthy, but the tone, owing to contraction of the muscular walls, is too great. This condition or stage has been termed "chronic arterial hypertension." This condition may be due to irritants circulating in the blood, to nervous tension, to incipient chronic interstitial nephritis, or may be the first stage of sclerosis of the arteries.
This may not be due to narrowing of the aortic orifice; it may be due to a sclerosis of the aorta. On the other hand, it may be due entirely to the hastened blood stream from the nervous excitability. This is probably the case if this sound disappears when the patient reclines. If it increases when the heart becomes slower and the patient is lying down, the cause is probably organic. Jour.
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.
Alkalies, whether potassium or sodium citrate or sodium bicarbonate, are often of advantage in so changing and aiding metabolism, or perhaps reducing the irritation from hyperacidity or a mild condition of acidosis, that their administration causes a lowering of blood pressure. Of course, in syphilitic sclerosis large doses of iodids are indicated and are valuable.
Mental disease began after father's death. Constant self condemnation. Suicidal. Exophthalmic goiter. Autopsy: Thyroid glandular hyperplasia. Mitral sclerosis. Aortic sclerosis with ulceration. Chronic endocarditis. Chronic diffuse nephritis. Scars of both apices of lungs, with small abscess of left apex. Emaciation. Brain weight 1050 grams.
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