HEART, Hypertrophy of.
The intrinsic hypertrophy of the heart caused by valvular disease or adherent pericardium is a natural conservative process, and should not be interfered with. When the causes which lead to cardiac enlargement are extrinsic and removable the indications for treatment are obvious. The cause should be removed if possible or its effect upon the heart minimised by judicious treatment. In cirrhotic kidney, for example, much may be done by a careful attention to dieting and to the functions of the skin and bowels, whereby the toxic products retained in the blood may be lessened by vicarious elimination. It is doubtful if any per manent good can be expected from attempts to reduce the general blood pressure by the continuous employment of vasodilator drugs. Unques tionably the use of these agents is most valuable for the relief of attacks of distress which are caused by some suddenly increased tension such as is due to mental strain, emotion, excessive muscular action, chills, constipation, &c., which are liable from time to time to arise in patients suffering from cardiac hypertrophy the result of continuous high blood pressure. In such cases Belladonna in small doses is recommended, but the writer has never seen much benefit from it.
When the hypertrophy is the direct result of such pulmonary embar rassment as exists in emphysema, fibroid phthisis, &c., the treatment of
secondary bronchitis or attacks of asthma by suitable measures is clearly indicated to prevent all undue demands upon the heart's action.
Hypertrophy caused by excessive muscular strain, whether the result of athletic exercises or laborious occupation, will gradually yield to moderate rest and a change in the individual's habits. The same result may be expected when the cardiac enlargement is due to Graves's disease or to increased peripheral resistance caused by the contamination of the blood by poisons like lead, tobacco, or gout as soon as the cause has been removed.
Though the treatment of hypertrophy as a symptom or sign by itself is unscientific and irrational, a further word may be said about the obvious error of prescribing cardiac sedatives like aconite, tartar emetic, &c., in compensatory hypertrophy when the cardiac action becomes tumultuous, irregular or painful. These symptoms should be regarded as evidence of threatening failure and not as proof of unnecessary force of ventricular contraction, and must he met by prompt rest and the judicious administration of heart tonics. In such cases Iodides are more clearly indicated than large doses of digitalis, as the systemic pressure is already high, and Strychnine with Strophanthus in moderate amount may be safely combined with them.