FATTY HEART AND OBESITY.
term "fatty heart" embraces two pathological distinct affec tions: (1) fatty infiltration, in which there is an abnormal accumulation of fat about the surface of the organ and in the interstitial tissue, and (2) fatly degenera tion, by which is meant the transforma tion of the cardiac muscle-fibres into fat. Both conditions are frequently concom itant to general obesity.
Fatty Cardiac Infiltration and Obesity.
Symptoms.—A well-marked degree of fatty overgrowth may be unaccompanied by any symptoms, although the bodily vigor may be impaired. These cases are usually combined with general obesity. The muscle-fibre is weakened (not de generated, as a rule), and as a conse quence dilatation of the organ tends to supervene; this excites dyspncea upon exertion. Under these circumstances, if extra labor is suddenly thrown upon the organ, from any cause whatsoever, the clinical indications of a weak heart (ur gent dyspncea, prwcordial discomfort, palpitation, vertigo, syncope, cyanosis) promptly appear and become pro nounced, followed later on by recur rences on every provocation.
In cardiac arliythmia, so frequently observed in the obese, the apprehension. of grave disease of the circulatory and respiratory apparatus usually enter tained is not warranted. Slight inter mittence after a series of regular beats,. followed by a pause, is observed in youthful patients with slight heart trouble, especially in young girls who exhibit the amemic form of lipomatosis. Actual irregularity, in which regular beats and pulse-pauses alternate, is seen chiefly in fat people who have already passed their fiftieth year, and in whom other symptoms of heart-trouble are present. Complete irregularity, in which pulse-waves alternating in ten sion and size regularly follow one an other, is seen in cases of obesity with marked heart-weakness, in which there is dyspncea, angina pectoris, oedema, and dropsy. Simple cardiac intermittency and slight irregularity are not unfavor able as regards prognosis, and these cases may, after a course of treatment.
directed to adiposity, recover their pulse-regularity. The occurrence, how ever, of complete irregularity, delirium Gordis, regarded as a sign of grave dis turbance of the heart-mechanism which can never be completely removed, and sometimes also premonitory of sudden death. Fisch (Berliner klin. Woch.,
Mar. 18, '95).
Distressing attacks of asthma may de velop after a full meal, or in the absence of any apparent exciting cause. A pas sive form of bronchitis, probably second ary to a weak heart, attended with the customary symptoms — cough and a slightly-colored expectoration — often arises.
Inspection shows a feeble, diffuse apex beat, though in marked obesity I have frequently found it absent. Palpation serves to confirm the existence of a feeble impulse. The radial pulse is variable, though, as a rule, regular and moderately tense. Percussion yields dullness over an increased area, although this is not demonstrable in excessive obesity. Aus cultation renders audible the feeble heart-sound in marked cases, and, with increasing dilatation, a systolic murmur. In moderate grades the heart-sounds may be clear.
The catabolic disorders of obesity ascribed to faulty thyroid activity arc due to: (1) disappearance of the thymus gland and marked development of the thyroids at the period of puberty; (2) the more frequent occurrence of thyroid affections in girls than in boys, which fact tends to explain the a»al ogy,—greater frequency of transitory obesity of adolescence among the pu bescent females; (3) our physiological and clinical experience as regards in crease in protoplasmic oxidation after administration of thyroid gland or its preparations. Heinrich Stern (New York Med. Jour., March 29, 1902).
Differential Diagnosis.—The diagno sis rests upon the combined presence of marked obesity and a weak heart. Al though there is little danger of con founding fatty overgrowth with other cardiac affections, the fact is to be kept in remembrance that its persistence favors the occurrence of fatty degenera tion, and it is not always possible to dis cern the sequence, since, as will appear hereafter, fatty degeneration may exist without engendering symptoms.