HEART, Dilatation of.
This in the majority of instances is the result of failing compensation when hypertrophy has been gradually giving way to increase in the capacity of the chambers of the heart as nutrition fails. Its treatment, therefore, is identical with the management of the last stages of valvular disease.
Some cases, however, are characterised by a sudden onset with alarm ing symptoms of embarrassed circulation occurring in subjects whose valvular affection has been undetected, or has remained quiescent till some severe muscular exertion has demonstrated that the reserve force of the heart was unequal to meet. the sudden demand made upon it. Such cases should be treated as instances of the following: Heart Strain.—This is liable to follow prolonged muscular exertion in a patient during the convalescent stage after recovery from any serious wasting disease or fever, and is frequently met with after influenza and typhus fever, in which affections the muscular fibres of the ventricles are weakened by the action of the toxins of these diseases. Udder the strain of some exertion, the muscle being unable to contract efficiently, blood accumulates in the ventricle and the condition of acute dilatation supervenes. This occurs in otherwise healthy individuals who, not being in training, undertake a muscular feat formerly accomplished with comparative ease, as a mountain climb or a long cycle run at the com mencement of the spring season.
The indications for treatment are clear; absolute rest in the horizontal position is imperative in order to reduce the tax upon the ventricles to a minimum. In very acute cases with great pulmonary embarrassment the volume of the venous blood in the body calls for reduction which can only be promptly effected by freely opening a large vein in order to relieve the engorgement of the right side of the heart. in less urgent cases a strong saline purgative preceded by a dose of Blue Pill will effect the same result and deplete the portal system.
The careful exhibition of Cardiac Tonics is also clearly indicated both in the sudden dilatation occurring in healthy hearts (that is, if dilatation ever occurs in a perfectly healthy heart), and in those where °id valvular impediments have previously existed. Strychnine can alone be pended upon to meet requirements which are urgent, and to ohta in its best results the drug must be administered hypodermically in a dose of to gr.
The following is a good routine combination of remedies for use when the most urgent symptoms have been relieved: Tinct. Strophanthi 5iss.
Tinct. Nucis romicx 5\j. sp. %num. rontat.
Aquae Cktoroforrni ad 3\-iij.
Ft. mist. cp. ass. ex aqua ter die.
At a later stage Schott-Nauheim treatment by baths and resisted movements is invaluable.