HEART, DISEASES OF TILE, a class of serious, and often fatal disorders affecting the great center of the circulation, the accurate knowledge of which may be dated from the application of auscultation (q.v.) and percussion to the purposes of diagnosis. The great names of Corvisart and Laennec stand foremost in the modern investigation of cardiac diseases, Dr. Hope of London, and a great number of living physicians, having largely contributed to the existing knowledge of the subject, which bad, however, been carefully studied by Morgagni and the great morbid anatomists of the 18111 c., as well as by Senac and Testa, without the advantage of the more recent means of diagnosis. The limits of this article admit of only a very slight sketch of a subject of vast extent, and on which the literature of the last 50 years is unusually copious and exhaustive.
Diseases of the heart may be roughly divided into the functional and organic—in the former of which no appearances adequate to account for the symptoms are found in the dead body, while in the latter the contrary is the fact. To the former class belong simple palpitation, syncope, and the peculiar disorder termed angina pectoris: to the latter, hypertrophy of the heart, dilatation of the cavities, with various structural diseases of the endocardiurn and pericardium, of the muscular fiber, and of its nutrient arteries. To these may be added the disease of the aorta, and especially aneurisms of its thoracic portion. We propose to review very briefly these different morbid conditions.
Palpitation, or undue and often irregular action of the heart, attended by uneasy sensations of movement, is a disorder common tci many organic diseases of the heart, and not unfrequently also occurring in debilitated states of the system, without any organic disease whatever. In exhausted and anxious men of business, in hysterical and anaemic women, in habitual smokers, in dyspeptics, in person's debilitated by discharges from the mucous membranes, a degree of palpitation is quiet common, and the symp tom sometimes assumes the apparent form of an independent disease, especially when aggravated by mental anxiety in respect to its true significance. The treatment is entirely guided by the facts of the individual case; but generally speaking, the negative results of physical diagnosis, with the positive knowledge of the cause, suffice to reassure both practitioner and patient, and lead to a correct adaptation of means to the end in view.
Syncope, or swooning, is, as every one knows, much more commonly a functional than an organic disease. See FAINTING.
Angina pectoris, or breast-pang, also called syncope anyinosa, is a peculiar painful or oppressive sensation, very characteristic of cardiac diseases, especially of such as are apt to prove suddenly fatal. It is needless to add that this form of disease is of great importance, and of very dreadful significance. The two leading elements in the sensa tion referred to, according to Dr. Latham, are the pain and the sense of impending death. The sensation is entirely different from breathlessness, although often mixed up with this in the mind of the patient. Where the sudden, death-like paroxysm of angina
comes on in the absence of medical assistance, the proper remedies are, warmth to the extremities, stimulants, and moderate doses of laudanum or opium; but no time should be lost in procuring the aid of instructed persons, as errors in the administration of these powerful remedies might be more rapidly fatal than the disease itself.
Asthma, and difficulty of breathing depending upon the lungs, especially that form of difficult breathing called orthopnoea, when the patient is unable to lie down in lied, arc symptoms very characteristic of some kinds of disease of the heart and great vessels.
The organic diseases of the heart arc very numerous; most of them are attended by one or other of the symptoms above mentioned, and almost all of them involve danger to life more or less considerable. It is nevertheless true that public opinion, nowadays, is prone to overrate the tendency to death, and especially to sudden death, in some of these diseases. Strictly speaking, a sudden death—i.e., a death quite unexpected, and in the midst of apparent good health—is a rare and exceptionM fact in organic disease of the heart; the most frequent instances being in connection with aneurisms (q.v.) of the great vessels, fatty degeneration of the heart's fiber, and extensive calcareous degeneration of the coronary arteries of the heart, often producing marked symptoms of anwina pectoris, as above referred to.
valvular diseases of the heart are among the most frequent and the most easily recognizable of its organic disorders. They depend essentially upon changes in the endoeardium, or internal lining membrane (endocarditis); in many cases these changes olig-inate in attacks of rheumatic fever (see ItnEumAus3.1), which is therefore to he viewed with suspicion as a disease tending to shorten life, especially when developed during early youth. The valves affected arc usually those of the left side, and the consequence may be either imperfect closure of the valve, leading to regurgitation of blood, or obstruction of the orifice. In either case, there is a mechanical impediment to the cir culation, of a more or less serious kind, followed by dilatation of the cavities of the heart and hypertrophy of the walls, especially of the ventricles.. Fora time the circu lation is kept up under these 'unfavorable conditions by increased efforts of the organ; but ultimately its balance is fatally disturbed, blood accumulates in the liver, the lungs, or others of the internal organs, and secondary diseases take place, of which dropsy (q.v.), albuminuria, and hmmoptysis, or spitting of blood, are among the most frequent and formidable.
Pericarditis, or inflammation of the pericardium, i.e., the heart-purse, or fibrous sac investing the heart, is, like endocarditis, a frequent consequence of acute rheumatism. In numerous instances, it ends favorably, but in some cases it is fatal by large effusion of fluid, and in others by adhesions between the external membrane and the heart.
The treatment of all these diseases must be strictly regulated by medical advice.