HEART, Fatty and Fibroid Degeneration of.
The acute form of fatty degeneration which supervenes in typhus fever, pneumonia, diphtheria, influenza, acute rheumatism, and phos phorus poisoning as a rule calls for little special treatment save what is clearly indicated for the management of the primary affection. The degenerative change passes away in young subjects under prolonged rest, which latter is essential in order to prevent the occurrence of acute dilatation of the heart, so liable to occur on any exertion.
The present article deals with the treatment of the form of degenera tion which supervenes in elderly subjects usually as part of a general senile arterial change, the type of which, though mainly fatty, is also nearly always more or less associated with the replacement of the muscular fibres by fibrous tissue. The term " cardio-sclerosis " defines this affec tion more correctly than the usual names of either fatty, fibroid or chronic myocarditis, since the degenerative process is of a compound or mixed nature.
This being also often the final result of or sequel to old and repeated rheumatic inflammation, the preventive treatment resolves itself into the judicious management of the valvular lesions which often accompany it. By judicious rest and dietetic treatment the stage of failing com pensation may be long postponed and the tendency towards cicatricial and fatty degeneration minimised.
When the symptoms of cardiac degeneration have obviously mani fested themselves, the probability is that the coronary arteries are already diseased and there is no hope of acting upon the altered muscular fibres, but life may be prolonged and the symptoms palliated by such measures as will increase the reserve force of the fibres which have still escaped attack. Everything which interferes with normal metabolism and all undue strain upon the weakened muscular tissue must be avoided.
The diet should be rich in nitrogenous material, starchy, fatty and saccharine materials being used sparingly. Alcohol, save when specially indicated for the relief of symptoms, and tobacco and strong tea or coffee should be avoided. Almost as important as the nature of the
food is its quantity and the distribution of the meals. Whilst gluttony is to be forbidden, the number of the meals should be increased, at least four being administered at intervals of not more than four hours each in the day. In this way the late heavy dinner or supper is done away with and a short rest after each meal instituted. As much time as possible should be spent in the open air; walking upon the level is the ideal form of muscular exercise, rising ground being avoided when possible, and negotiated with slowness when unavoidable.
Many patients suffering from cardio-scicrosis succumb finally to some sudden and unguarded act of exertion, as in a brief rush to catch a train or keep an appointment. The ascent of steep stairs when unavoidable should he always made by placing both feet upon each step before the ascent of the next one is attempted, and when this habit becomes acquired such exercise becomes beneficial, as it is impossible for the patient to hasten or tax his heart much more than in level walking. Golf may be permitted in most cases.
Business pressure, worry, creative mental work and all emotional strain must be given up, the even, quiet, uneventful life suitable for the victims of angina pectoris being substituted for the previous busy existence.
Sleep is of vital importance, as insisted upon by Mackenzie, who re commends Bromides, when restlessness is present, and Chloral when the nights are disturbed by attacks of distressful breathing; Paraldehyde is, however, a drug always to be preferred to any other narcotic in cardiac degeneration when an hypnotic is indicated. A short walk immediately before lying down is the best of all sleep producers for patients who are still able to move about all day. Constipation should never be permitted; the bearing down associated with the passage of a constipated motion is not a trivial danger.