Enlargement or Hypertrophy of the Ventricles.
THIS is simply a thickening, or an increase of bulk, in the walls of the ventricles. The muscles composing the walls of one or both of these cavities grow thick and large.
Physical Signs. Impulse stronger than natural. When considerable, it is accompanied with a lifting and heaving of the parts. Dull sound on percussion over a larger space. First sound of heart prolonged; second sound feeble. The interval of silence, shorter than natural. In bad cases, the second sound is nearly extinguished.
General symptoms. Hypertrophy of left ventricle gives a strong, prolonged, and tense pulse. Palpitation more constant than in any other disease of the heart. In advanced stages, the patient is easily out of breath. There is a rush of blood to the head on making exertion or stooping, with more or less throbbing and lancinating headaches, which are aggravated by suddenly lying clown or rising up. There are vertigo, ringing in the ears, sparks of light and other illusions before the eyes; also a purplish, violet or livid color upon the cheeks, nose, and lips. In many cases there is a dull, severe aching pain in the region of the heart, and extending towards the shoulder and the inside of the arm.
When the right ventricle is enlarged, there is a swelling of the external jugular veins.
Causes. The walls of the heart are thickened by overwork, in the same way that the blacksmiths arm is made muscular and large. All muscles grow in the same way. More action sends more blood to them, and this causes an increase of nutrition.
Whatever interposes an obstacle to the passage of the blood through the valvular openings, will cause the ventricles which force it through to work harder. Hence, obstructions in the semi lunar valves cause hypertrophy of the ventricles.
Any excitement of the mind, or any great exertion, which causes the heart to beat harder and faster, if it be often repeated, will induce a thickening of the ventricles.
Treatment. First, remove, as far as possible, all causes of excitement which produce palpitation. If the head is much affected, apply wet cups to the back of the neck. The same may be applied over the heart. This will generally improve the symptoms at once. A blister placed over the heart will likewise make a favorable impression.
The meals should be taken at regular intervals, and should be very light. The food should be plain and simple, and composed much more of vegetable than of animal food. In fact, the diet should be so spare as slightly to reduce the strength.
The patient should be careful never to take violent exercise, or, indeed to be in a hurry about anything. In bad cases, walking up hill, or against a strong wind, is often out of the question, and must in any case be attempted with great caution. Staircases are. to be shunned as enemies. An attempt to run, even to avoid being left by the cars might, in some cases, prove immediately fatal. Carriage riding is not objectionable.
The passions must be held in the most thorough subjection. Excitements of all sorts are dangerous, and must be avoided.
For the first week or two of treatment, active purgatives will be useful. For this purpose, Epsom salts and senna will answer a good purpose, and should be used so as to procure two or three watery stools a day.
In addition to this, some sedative to lessen the force of the hearts action is generally needed, especially when there is considerable palpitation. For this purpose, tincture of black cohosh, and tincture of skullcap, or the former with tincture of digitalis (285), (94), are quite useful. Three to ten drops of tincture of the American hellebore (veratrum viride) will reduce the action of the heart perhaps more effectually than any other medicine, for a few days or weeks.
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