=Myocarditis= is an acute or chronic inflammation of the heart muscle.
In many cases where the muscle substance of the heart is diseased,
there is no doubt that =osteopathic lesions= are potent underlying
factors. The lesions lessen nervous integrity and thus have a direct
bearing upon the muscular strength and the likelihood of inflammatory
invasion.
=Acute Interstitial Myocarditis.=—This affection is met with in fevers,
in connection with endocarditis and pericarditis. Of the infections
diphtheria and typhoid are the most frequent. Septic emboli may block
the coronary arteries in pyemia, septicemia and malignant endocarditis
and cause infarcts in the myocardium with abscess formation. It may be
a complication of gonorrhea. Males are affected more often than females.
=Pathologically=, in =acute interstitial myocarditis= the changes take
place in the intermuscular connective tissue. This becomes swollen
and round-cell infiltration takes place. The muscle substance is pale
and soft. =Acute parenchymatous degeneration= is characterized by
degeneration of the muscle fibers, which are infiltrated with granules.
The cardiac muscle throughout is pale and soft. =Acute suppurative
myocarditis= is a rare condition. In this form abscesses occur, which
vary in size from a pin’s head to a pea. They vary greatly in number
and are usually multiple. They may not cause any disturbance and may
not be recognized before death. On the other hand the abscess may
rupture into the heart cavities or the pericardium, or it may perforate
the intraventricular septum, thus allowing the venous and arterial
blood to intermingle. It may cause a cardiac aneurism.
=Symptoms.=—These are very uncertain. If during the course of any
of the causal diseases, the pulse suddenly becomes rapid, small and
irregular and compressible and palpitation and syncope develop, all of
which point to cardiac weakness, myocarditis may be suspected. Signs
of venous stasis develop later in the affection. The physical signs
are those of dilatation. This is extremely grave. Cases do, however,
recover.
=Treatment.=—The treatment is the same as that given under endocarditis
and pericarditis. Rest in bed is absolutely necessary. Pay particular
attention to the nourishment and to the hygienic surroundings of the
patient. Especially attention should be given to the upper dorsal area,
both to the muscles and the interosseous lesions, for this influences
cardiac muscle innervation and nutrition. Then lesions of the upper
cervical are important owing to their relationship to the vagi which
control muscular impulses of the heart muscle.
=Chronic Interstitial Myocarditis.=—Among the causes of this form
of myocarditis are the excessive use of tobacco or alcohol; gout,
rheumatism, malaria, diabetes, chronic nephritis, syphilis and lead
poisoning. Acute interstitial myocarditis may lead to the chronic
form. This form is “commonly caused by the narrowing of a coronary
branch in a process of obliterative endarteritis” (Osler). It may be
due to injuries of the anterior and lateral portions of the chest.
Unquestionably =osteopathic lesions= of the upper dorsal vertebræ and
ribs and cervical region affect the integrity of the heart muscle and
predispose to congestion, inflammation and debility of the tissue.
Males of middle life are more predisposed to chronic myocarditis.
The =pathological changes= occur most frequently in the left ventricle
and the septum, but they may occur in any portion. The patches and
streaks that are in the walls are sometimes only seen upon very careful
examination. They are of a gray or grayish-white color, and when fibers
that have undergone fatty degeneration are intermingled, they have a
grayish yellow tint. The condition may be associated with hypertrophy
and dilatation. A part of one of the heart cavities may become dilated,
producing what is known as cardiac aneurism. There is destruction of
the muscular fasciculi with subsequent development of new fibrous
tissue. Fatty degeneration is also seen.
=Symptoms.=—Advanced fibroid myocarditis may be present without any
symptoms. Slight degrees present no symptoms. The symptoms when present
are: a feeble, irregular, slow pulse; attacks of angina pectoris and
sometimes arhythmia. The blood pressure is increased. Upon exercising
there is more or less pain, cardiac distress and dyspnea. If fatty
degeneration is also present the pulse will be quickened and irregular.
=Diagnosis.=—This is often very difficult and it requires careful and
persistent study of a case to be able to make a correct diagnosis.
=Prognosis.=—This is grave, though unquestionably a number of cases
have been distinctly improved through osteopathic methods. Sudden
death is liable to occur at any time from complete obstruction to the
coronary arteries, as this condition is associated with sclerosis and
narrowing of these arteries or their branches.
=Treatment.=—The treatment of chronic myocarditis is largely included
in chronic endocarditis. The cause of the disease should be determined,
if possible. Careful treatment to the ribs of the left side, from the
first to the sixth, and the corresponding vertebræ, will be of great
aid in controlling the disease. The cervical region demands attention,
owing to the influence of the vagi on conduction of the heart impulse
and to vasomotor effect. Attention should be given to the diet and
hygiene of the patient. Outdoor life, bathing of the skin, and careful
treatment of the vasomotor nerves will be of great help.
Direct attention to the entire splanchnic region as vasomotor control
here materially lessens the work of the heart and assists generally in
maintaining the digestive and nutritive functions.