Chapter 8 - Diseases of the Heart
Introduction to Heart Diseases
Impulse of the Heart
Sounds of the Heart
Percussion Sounds
Altered Sounds of the Heart
Enlargement of the Ventricles
Dilatation of the Ventricles
Interior of Lungs, Liver, Heart, and Stomach - Diagram
Hypertrophy with Slight Dilatation
Dilatation with Slight Hypertrophy
Tumors of the Heart
Softening of the Heart
Induration of the Heart
Fatty Degeneration of the Heart
Shrinking of the Heart
Acute Inflammation of the Heart Case
Chronic Inflammation of the Heart Case
Carditis
Inflammation of the Lining of the Heart
Chronic Inflammation of the Lining of the Heart
Disease of the Semi Lunar Valves
Disease of the Mitral Valves
Water in the Heart Case
Palpitation of the Heart
Neuralgia of the Heart
Polypus of the Heart
Displacement of the Heart

8.7 Dilatation of the Ventricles

Dilatation of the Ventricles.

The several cavities of the heart hold about one and a half ounces each. Dilatation is simply an enlargement of these cavities, so that they will bold more. And this increase in the size of the cavity in simple dilatation is generally at the cost of the walls, which are made thinner and weaker, just as the walls of a bladder are made thinner by blowing into it and increasing its internal dimensions.

Physical Signs. Impulse more abrupt, and less marked than natural. Dull sound on percussion commensurate in extent with the dilatation. The first beat of the heart, clearer, louder, and shorter than natural, and more nearly resembling the second.

General Symptoms. Difficulty of breathing; terrific dreams; starting from sleep; swelling of the feet and legs; purple, violet, or blue color of the cheeks, nose, lips, and especially around the eyes; feeble and oppressed palpitation; various disturbances in the head; bleeding from the nose, stomach, bowels, and womb; and frequently enlargement of the liver.

Explanations. The first sound of the heart is short and not well marked, in consequence of the muscular walls of the ventricles in this disease being thin and in a weakened condition, so that every stroke they make is short, quick, and spasmodic, instead of strong and lifting, as in hypertrophy. For the same reason, the impulse is a brief blow dealt the walls of the chest, which gives a slight shock, but has not power enough to lift the chest up. The blow is quick, because the muscle is thin and can contract quicker than a thick one.
Dilatation, by thinning the walls of the cavities, enfeebles the heart, and shows us an obstructed circulation. Accordingly the blood is not transmitted by the left ventricle, and being retained in the lungs, it causes a crowded state of the vessels, and difficulty of breathing; also congestion of the brain, with terrific dreams, etc. And this engorgement of the lungs, being propagated backwards to the right heart, great veins, and all their ramifications, produces dropsy of the feet and legs, discoloration of the face, passive hemorrhages, and congestion of the brain, liver and membranes. Fig. 95 gives an idea of how all this happens.

Treatment. As in many other diseases, search out the causes, and remove them. If it be obstruction of the circulation in the lungs by bronchitis or other complaint, that needs the first attention. If it be caused by violent exercise, by strong emotions of the mind habitually indulged, or by drunkenness, or any other irregularity of life, these habits must be corrected without delay.
If it be caused by organic disease of the valves of the heart, relief cannot be so readily obtained; but even in these cases, it is to be sought and expected.
The circulation is to be kept as tranquil as possible by a strictly quiet and orderly life, and a plain, moderate, unstimulating diet. In this disease, however, it should be more nutritious, and composed to a larger extent of meats, than in hypertrophy.
In some cases the general health and tone of the system will need to be improved by bitters (50), (67), (64), (69), (79), mineral acids (60), iron (269), (61), and aromatics (115). The compound mixture of iron is a good preparation when this mineral is called for by a low state of the blood.
The stomach should be kept in the best possible condition, as a very small disturbance of it, even from acidity, will set the heart to beating very violently
If hysterical symptoms are present, the compound galbanum pill, and valerian (97), and other nervines will be called for.
In attacks of great difficulty in breathing, immerse all the extremities in warm water, and throw a blanket around the patient to promote sweating, at the same time admitting fresh air to satisfy the desire for breath. Give a draught, composed of ether, camphor, ammonia, etc. (135). This may be repeated two or three times, at intervals of half an hour, or an hour, according to the urgency of the case.

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