The term "simple dilatation" may be applied to the dilatation of one
or both ventricles when there is no valvular lesion and when the
condition may not be called broken compensation. The compensation
has been sufficiently discussed. Dilatation of the heart occurs when
there is increased resistance to the outflow of the blood front the
ventricle, or when the ventricle is overfilled with blood and the
muscular wall is unable to compete with the increased work thrown on
it. In other words, it may be weakened by myocarditis or fatty
degeneration; or it may be a normal heart that has sustained a
strain; or it may be a hypertrophied heart that has become weakened.
Heart strain is of frequent occurrence. It occurs in young men from
severe athletic effort; it occurs in older persons from some severe
muscle strain, and it may even occur from so simple an effort as
rapid walking by one who is otherwise diseased and whose heart is
unable to sustain even this extra work. All of the conditions which
have been enumerated as causing simple hypertrophy may have
dilatation as a sequence.
Degeneration and disturbance of the heart muscle and cardiac
dilatation are found more and more frequently at an earlier age than
such conditions should normally occur. Several factors are at work
in causing this condition. In the first place, infants and children
are now being saved though they may have inherited, or acquired, a
diminished withstanding power against disease and against the strain
and vicissitudes of adult life. Other very important factors in
causing the varied fortes of cardiac disturbances are the rapidity
and strenuousness of a business and social life, and competitive
athletics in school and college, to say nothing of the oversmoking
and excessive dancing of many.
The symptoms of heart strain, if the condition is acute, are those
of complete prostration, lowered blood pressure, and a sluggishly,
insufficiently acting heart. The heart is found enlarged, the apex
beat diffuse and there may be a systolic blow at the mitral or
tricuspid valve. Sometimes, although the patient recognizes that he
has hurt himself and strained his heart, he is not prostrated, and
the full symptoms do not occur for several hours or perhaps several
days, although the patient realizes that he is progressively growing
weaker and more breathless.
The treatment of this acute or gradual dilatation is absolute rest,
with small doses of digitalis gradually but slowly increased, and
when the proper dosage is decided on, administered at that dosage
but once a day. Cardiac stimulants should not be given, except when
faintness or syncope has occurred, and if strychnin is used, it
should be in small closes. The heart nay completely recover its
usual powers, but subsequently it is more readily strained again by
any thoughtless laborious effort. The patient must be warned as
carefully as though he had a valvular lesion and had recovered from
a broken compensation, and his life should be regulated accordingly,
at least for some months. If he is young, and the heart completely
and absolutely recovers, the force of the circulation may remain as
strong as ever.
Sometimes the heart strain is not so severe, and after a few hours
of rest and quiet the patient regains complete cardiac power and is
apparently as well as ever; but for some time subsequently his heart
more easily suffers strain.
Chronic dilatation of the heart, However, perhaps not sufficient to
cause edema, slowly and insidiously develops from persistent
strenuosity, or from the insidious irritations caused by absorbed
toxins due to intestinal indigestion. A fibrosis of the heart muscle
and of the arterioles gradually develops, and the heart muscle
sooner or later feels the strain.
It is now very frequent for the physician, in his office, to hear
the patient say, "Doctor, I am not sick, but just tired," or, "I get
tired on the least exertion." We do not carefully enough note the
condition of the heart in our patients who are just "weary," or even
when they show beginning cardiovascular-renal trouble.
The primary symptoms of this condition of myocardial weakening are
slight dyspnea on least exertion; slight heart pain; slight edema
above the ankles; often some increased heart rapidity, sometimes
without exertion; after exertion the heart does not immediately
return to its normal frequency; slight dyspnea on least exertion
after eating; flushing of the face or paleness around the mouth, and
more or less dilatation of the veins of the hands. All of these are
danger signals which may not be especially noted at first by the
individual; but, if he presents himself to his physician, such a
story should cause the latter not only to make a thorough physical
examination, but also to note particularly the size of the heart.
It a roentgenographic and fluoroscopic examination cannot be made,
careful percussion, noting the region of the apex beat, noting the
rapidity and action of the heart on sitting, standing and lying, and
noting the length of time it takes while resting, after exertion,
for the speed of the heart to slacken, will show the heart strength.