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Diseases Heart

inflammation, excessive, blood, heart-muscle, consequence, fever and typhoid

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HEART, DISEASES OF.----As pointed out in the chapters on anatomy, the heart is to be considered as a two-sided, muscular pump. On one side it pumps blood into the lungs to be aerated—the lesser circulation ; on the other it pumps blood into the arteries to be carried to all parts of the body— the greater circulation. The movements of the two sides are co-ordinated 1w the cardiac nerves. Hence disease may make itself manifest in at least three different parts of the organ. It may affect the muscular walls of the heart ; it may involve the valves of the heart ; or the nervous mechanism that causes the harmonious beating of the two sides of the heart may be interfered with.

Affections of the muscular walls result, as a rule, either from excessive action of the heart (as is seen in athletes, soldiers who make forced marches, labourers who lift heavy weights, etc.), or from the injurious effects exerted by poisons upon the muscle tissue. Alcohol, tobacco, syphilis, etc., are among the most frequent causes ; while the poisons of acute infectious diseases (pneumonia, typhoid fever, etc.) also exercise a marked effect upon the heart-muscle. Diseases of the valves may be due to defects in their mode of formation at birth ; to the growths of micro-organisms (as in acute articular rheumatism, scarlet fever, pneumonia, typhoid, etc.) ; or to the deleterious influences of the syphilitic virus. The nervous defects are numerous. Distension of the stomach, indigestion, fear, worry and over work—all exert their influences upon the nervous mechanism. In some disorders (as EXOPHTHALMIC GOITRE) excessive rapidity of the heart-beat may be noted ; while in other diseases the opposite is observed. Only the more important heart-disorders can be here considered.

Inflammation of the Heart-Musele.—Acute inflammation of the heart muscle may occur in the course of infectious diseases (such as articular rheumatism, typhoid fever, scarlatina, pneumonia, diphtheria, influenza, puerperal fever, and septicaemia), in connection with inflammation of the pericardium, or, rarely, as a consequence of excessive physical exertion.

Chronic inflammation of the heart-muscle, by which the musculature is transformed into callous and tendinous connective tissue, may either result from the acute form, or may develop in consequence of poisoning by alcohol, lead, or tobacco, or as a result of syphilis, gout, diabetes mellitus, chronic inflammation of the kidneys, malaria, or inflammation of the peri cardium. This disease includes also that form of degeneration of the heart-muscle which occurs in general arteriosclerosis in consequence of an affection of the coronary vessels of the heart. These vessels supply the heart with blood. But inasmuch as the heart can be nourished only during the intervals of rest, it follows that continuous demands upon this organ NVill lead to an impairment of nutrition. Such excessive demands are made upon the heart when it is called upon to overcome the great resistance offered to the circulation of the blood in consequence of calcification of the arteries.

A similar over-taxation of the heart arises owing to the increased amount of water which is present in the blood in chronic inflammation of the kid neys. The excessive use of cold baths, constant mental emotions, and severe physical over-exertions (including excessive gymnastics) likewise increase the labour of the heart. Excessive physical exertions may also lead to a rapidly appearing dilatation and relaxation of the heart-muscle, with all the symp toms of cardiac weakness ; or they may cause a gradual enlargement of the heart, with thickening of its walls. See ENLARGEMENT OF THE HEART.

Affections of the musculature of the heart manifest themselves princi pally in certain changes of the pulse. Further signs of a weakened activity of the heart-muscle consist in shortness of breath, oppression of the chest, rush of blood to the head, ringing of the ears, vertigo, headache, insomnia, blue discoloration of the skin, and bronchial catarrh. If the heart itself has become appreciably weakened, the same manifestations occur as described under Defects of the Valves of the Heart.

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