In fatty degeneration, the sarcous substance of the fasciculi is
converted into fat. In fatty overgrowths there is an excess of fat in
and about the heart.
=Fatty degeneration= is very common and is due to an interference with
the nutrition of the cardiac muscles. It is found in the impaired
nutrition of old age, of cachectic states, of grave infectious diseases
and of wasting diseases. In poisoning by arsenic and phosphorus,
intense fatty degeneration is produced. Pericarditis may be associated
with changes in the superficial layers of the cardiac muscle. Lesions
of the coronary arteries will produce this condition; also impairment
of the oxygen-carrying power of the blood. It occurs most frequently
in men after forty years of age. The affection may be either general
or local. It is most commonly seen in the left ventricle. When the
condition is general the heart is dilated, flabby and relaxed.
Microscopically, the muscular fasciculi exhibit a loss of nuclei, and
oil drops and granules appear in the fibers. The affection may be
present without any noticeable symptoms. Slight degrees and localized
fatty degeneration are unrecognizable. =Dilatation= must be present to
produce =symptoms=. This is apt to occur early. Dyspnea; asthma; cough;
angina pectoris; dropsy; slow, weak pulse; palpitation, and toward
the end, Cheyne-Stokes breathing may appear. Mental symptoms, such as
maniacal delusions, may come on and last for weeks. =Prognosis= depends
upon the cause and extent of involvement.
The =treatment= is largely that of dilatation of the heart. An effort
must be made to determine the cause, and treatment should be applied
accordingly. Considerable can be done in improving the nutrition of the
tissues of the heart by hygienic and dietetic measures. Light exercises
will often be of aid, but care has to be taken that the exercises do
not tax the patient too severely. A general treatment of the body will
be a helpful measure in invigorating the system as a whole and toning
the cardiac tissues. The diet should be nutritious; largely nitrogenous.
Raising the ribs over the heart and increasing the chest expansion will
be of help in cases where there are attacks of dyspnea and angina. Many
cases present deep seated lesions in the upper dorsal region. When
there are attacks simulating apoplexy, lay the patient flat upon the
back with the head slightly elevated.
=Fatty overgrowth= is associated with general =obesity= and sooner
or later this infiltration impairs the nutrition of the cardiac
muscle and true fatty degeneration results. This form occurs more
frequently in men, and between the ages of forty and seventy years. The
characteristic changes consist of an increase in the normal fat. The
heart may be enclosed in a thick covering of fat. The fat may also be
deposited between the fasciculi, sometimes reaching the endocardium.
Fatty overgrowth is certain to exist in extreme obesity. No =symptoms=
are produced until the muscular fibers weaken so that =dilatation=
occurs. The presence of extreme obesity, combined with signs of
cardiac weakness, point to fatty overgrowth. The =treatment= of fatty
overgrowth of the heart is largely the same as that of obesity.
Oertel’s method of lessening the amount of liquids, proteid diet and
graduated exercises is effective in cases where heart compensation is
intact.