Another form of this affection consists in a fatty degeneration of the heart-muscle itself. This may be due to a disturbance of nutrition, which may develop as a further consequence of fatty heart ; or it may be an in dependent affection, at times arising from poisoning (as by arsenic, anti mony, phosphorus, alcohol, or tobacco). In this form of the affection the fat is not deposited between the muscle-bundles, but the muscle substance itself is transformed into fat. The affection may arise also as a result of calcification of the coronary arteries of the heart, in severe diseases of the blood, or as a consequence of constant over-exertion in the presence of an enlarged heart. Certain infectious diseases, as puerperal fever, typhoid, diphtheria, smallpox, malaria, and tuberculosis, may likewise give rise to fatty degeneration of the heart.
The symptoms due to fatty degeneration of the heart are : palpitation, sensations of fear and oppression, shortness of breath, changes of the pulse, etc. These manifest themselves even when the body is fully at rest, but are intensified after the slightest bodily exertion and upon mental work and excitement. Measures tending to overcome this affection are primarily directed toward combating the general obesity. Anti-fat cures, undertaken by the patient on his own responsibility, are apt to be exaggerated, and may often be followed by injurious consequences. Thus, if the fatty cushion of the heart is made to disappear rapidly, the heart loses a support, and relaxation and dilatation of the organ are very liable to arise. The diet should he restricted principally to meat, vegetables, and fresh fruit ; whereas starchy foods, sugar, and large quantities of fluid should be avoided.
Palpitation of the Heart.—Even under normal conditions the activity of the heart is influenced by the individuality of its possessor. Age, dis position, emotions, etc.—all exert their various influences upon this organ. It is not only the mental emotions or physical exertions, however, which manifest an action upon the heart ; for, owing to the intimate correlation existing between this organ and all the other viscera of the body, most physi cal and nervous affections are accompanied by deviations from the normal heart-beat. Palpitation of the heart becomes of importance when a dis turbance of the rhythm occurs in addition to acceleration and intensification of the heart-beats, or when it sets in upon the slightest bodily exertion un accompanied by any other external cause. Besides being an early symptom
in almost all diseases of the heart, palpitation is noted principally during fever, in anxinia, and in many cases of poisoning.
Very frequently the palpitation is a purely nervous symptom, being present regularly in anxtnic, excitable, or nervous individuals. It consists in a more or less marked increase in the rate of the heart-beat. This conies on in attacks, and is associated with vertigo, headache, sensations of fear and oppression, pains in the region of the heart, flushed face, and increased perspiration. Women are especially liable to such attacks during the periods of adolescence, menstruation, and the menopause. Palpitation often results from too good living. Over-filling of the stomach, accompanied with digestive disturbances, is the most important cause. Other causative factors arc : constipation ; hxmorrhoids ; sexual excitement ; excessive use of tea, coffee, alcoholic beverages, or tobacco ; exophthalmic goitre, and con valescence from severe, especially febrile, diseases. Thus it may be seen that cardiac palpitation may be the expression of a trifling disorder or the result of grave disease. To determine the exact cause of palpitation requires the best medical skill obtainable.
Spasm of the Heart (Angina Pectoris).—An affection which is characterised by sudden acute pains in the region of the heart, occurring without any external cause. These pains are usually excruciating, and often radiate into the left shoulder and left arm, frequently causing sensations of cold or of numbness in these parts. The patient has a feeling as if the heart were held in an iron grip by an invisible hand, or were being torn to pieces. The pains may become so violent that they almost suggest a wish for the destruction of life. At the same time there are usually present a marked feeling of oppression, a sensation of fear, shortness of breath, changes of the pulse, pallor of the face, and cold perspiration ; fainting spells and con vulsions are not as frequent. The affection occurs as a result of calcifica tion and dilatation of the arteries, in defects of the valves of the heart, and in affections of the heart-muscle ; but it may be due also to gout, hysteria, and neurasthenia, or to the effects of severe colds, mental emotions, physical over-exertions, and the abuse of alcohol and tobacco.