OVERGROWTH, ATROPHY, AND DEGENERATION.
Overgrowth (Hypertrophy) and Dilatation of the heart have been noted as results of valve disease. But either may occur independently of any valve disease, and is then spoken of as simple hypertrophy and simple dilatation, and the two may be combined.
Simple hypertrophy occurs as a result of excessive stimulation of the heart, for instance, excessive exercise. It is thus not infrequent in athletes, by over-exertion in swimming, and specially by swimming under water and exces sive diving. Simple hypertrophy may also occur as the result of excessive smoking, and then the heart becomes tumultuous in its beat. The treatment of such cases is by rest and avoid ance of the excess.
Simple dilatation may follow overstrain, and is common when the heart muscle is weakened by, for example, the poison of influenza. I am persuaded th!tt dilatation is very often pro duced in the young and immature by prolonged bicycle-rides, specially if there is much uphill work or running against the wind. It is pro bably invariable in prolonged cases of anaemia. For such cases tonic and iron treatment is best, and nothing produces so remarkable results as the Nauheim treatment (p. 487, Vol. II.).
Atrophy of the heart is the opposite of over growth, and is a consequence of wasting dis eases, such as consumption, diabetes, &c. In it the action of the heart is feeble, and the beat against the chest wall weak. The treatment is that of the bodily condition of which it is a consequence.
Fatty Degeneration of the heart is a con dition of advanced life, and is produced also by acute fevers and by poisoning with phosphorus. It is also a frequent result of such inflammation as has been described under INFLAMMATION OF THE PERICARDIUM, p. 318.
In fatty degeneration the muscular fibres of the heart substance are affected. The proper substance of the fibres is replaced by oily par ticles, and the muscular tissue is in consequence weaker and more easily torn. The degeneration is usually in patches in certain parts of the heart's substance; these parts are weaker than others. Fatty degeneration is a cause of sudden death. The soft fibres readily give way under some strain, even though it be slight, the excite ment of some sudden emotion, and a tear occurs in the substance of the heart, through which the blood passes into the surrounding pericardial sac. Thus fatty degeneration is one cause of rup ture of the heart; and the phrase "a broken heart" contains a literal truth.
The symptoms are those of feebleness of the heart. The pulse is weak, and the heart sounds feeble. There is general weakness, a tendency to breathlessness, giddiness, and faint ness.
The symptoms of rupture of the heart are sudden severe pain about the heart, gasping for breath, fainting, and speedy, in many cases instantaneous, death.
The treatment of such a condition as fatty degeneration is simply such as will maintain the strength of the person as much as possible. A very moderate, carefully adjusted diet (poor in fats, sweets, and starches), gentle exercise, fresh air, &c., are demanded, as well as iron and similar tonics. It is plain that all excite ment, worry, &c., must be avoided.
It may be noted that rupture of the heart may be produced by external violence, and that immediate death even from a wound is not invariable. The wound may be blocked by blood clot, &c., and death be delayed.