DILATATION OF THE HEART.
Definition.—Increase in the size of the heart, due to enlargement of one or more of its cavities. Clinically, "dilatation" is applied to an enlarged, but failing, heart displaying the phenomena of "ruptured compensation." Varieties.—"Simple" dilatation is the term used to denote that condition in which the walls of the heart remain of comparatively normal thickness. Inas much, however, as the cavities, and con sequently their walls, are more extensive than normal, simple dilatation is asso ciated with a certain amount of hyper trophy. Dilatation is "hypertrophic" when the heart-walls are thicker than normal. Another name is "active" dila tation; and viewed froni the opposite stand-point it becomes "eccentric hyper trophy." In "atrophic," or "passive," dilatation the walls are thinner than normal.
Most cases of dilatation are essentially chronic in their development and pro gress. Some, however, are acute.
Symptoms.-11sually the earliest indi cation to the patient of his trouble is shortness of breath. This at first is ap parent only upon exertion, but in well developed cases it becomes a source of great suffering. Hardly more than one word can be uttered without a pause for breath; and sleep, if obtained at all, is possible only in the vertical position (orthopnma). The ordinary automatic respiration has sometimes to be supple mented by voluntary efforts; so that when sleep does come the dyspncea be comes aggravated and soon wakes the patient.
Another early synaptom is palpitation with a sense of discomfort or oppression in the cardiac region. It is singular that the powerful heave of an hypertrophied heart does not seem to obtrude itself upon the consciousness of the patient sa much as the feeble flutter of dilatation_ There may also be a cough, with white, frothy, serous expectoration. The poor circulation in tbe brain is evidenced by more or less mental slowness and easy fatigue, with impaired memory, despond ency, ill-temper, and attacks of faintness. In the digestive tract the passive conges tion of the stomach is evidenced by fer mentation, heaviness, nausea, and even vomiting. The bowels are usually slug gish, and the urine is scanty and high colored, with a deposit of mates.
In mild degrees of dilatation the com plexion is pale, in more advanced cases dusky or cyanotic with blue lips and finger-nails. The extremities are apt to be cold to the touch, and the sluggish ness of the capillary circulation is illus trated by the slow return of color to any point of the surface after firm pressure: the shape of the examiner's hand is, as it were, stenciled upon the cyanotic sur face. The labored breathing is noticed
even while the patient is at rest, but becomes striking upon the least exertion. CEdema invades first the ankles, thence creeps upward to the thighs and pu denda, and finally invades even the face and arms. Ascites and hydrothorax are often present. It is not unusual to find a considerable amount of fluid in one side of the chest, while the other pre sents merely the signs of adema. The eyes are somewhat prominent and glassy. Frequently the liver is much enlarged, reaching even to the level of the navel. This change in its size may be more or less obscured by the ascites present, but in that case can often be demonstrated by a quick, though gentle, pressure of the fingers inward (ballottement). In some cases the spleen is also found to be en larged.
Cardiac dilatation, to a moderate ex tent, is far from uncommon in early life; indeed, in childhood the heart may be said to dilate with especial ease. The dilatation may be found out apart from any valvular affection; it is due to blood-pressure in a flabby, ill-nourished, or deg,encrated heart, and may occur without there being any resistance to the passage of blood from the heart. Acute infections, such as broncho-pnen monia, diphtheria, and acute rheuma tism are particularly liable to cause this. ln any such case of acute disease where the dilatation is rapid, a recumbent posi tion sholild lie enforced, and on no pre tense should the patient be allowed to lift even his head from the pillow. The diet should be regulated so that those foods that tend to ferment and till the stomach with wind should he forbidden; baked apples, grapes, orang,es, and acid fruits are to be avoided. The patient shmild be fed with milk, enstards, strong soups, yelk of egg. and rusk. Tn the matter of drugs, if the ease be a rheu matic one, and sodium salieylate being taken, it is well to combine with it 5 to 10 grains- of iron ammonio-citrate. Strychnine is of great avlue, and iron perchloride with solution of strychnine, given in full doses well diluted with fazrated water, is recommended. Enstace Smith (Practitioner; Amer. Jonr. Med. Sci.. June, 1902).