Arteriosclerosis.
Synonyms:—Atheroma; arterial sclerosis; endarteritis; arterio-capillary fibrosis.
Definition:—A condition of increased growth—overgrowth—of the connective tissue, first, of the arterioles, and second, of the larger vessels, into which calcareous matter is ultimately deposited. The condition is more common in the aged and in those who have been intemperate and have led a life of general dissipation; also those who suffer from lead poisoning or from chronic interstitial nephritis. The condition involves, first, the aorta, then the coronary arteries and subsequently the arteries of the brain, and then those of the extremities. The mesenteric arteries and the arteries of the stomach and liver are seldom affected.
Symptomatology:—One of the early apparent symptoms is a displacement of the apex beat of the heart, which will be found to be displaced downward and to the left, with an increased force in the impulse. Other symptoms may not be apparent until the disease has been present for perhaps a number of years. If the affected artery is somewhat superficial, so that it can be felt, it will be found to be structurally hard and incompressible. As the disease progresses the pulse wave is influenced until ultimately it can scarcely be felt. This is due to the loss of elasticity in the walls of the vessels. This condition directly influences the heart, increasing its work and thus inducing hypertrophy of the left ventricle as a common sequel. This may become sufficiently exaggerated to completely mask the evidences of arteriosclerosis. There will be farther a sensation of precordial constriction with some pain and perhaps a subsequent development of angina pectoris. Palpitation on any exertion, with difficult breathing, are not uncommon.
When the condition affects the cerebral arteries, there is syncope, vertigo, persistent and intractable headaches, tinnitus aurium and subsequently local paresis. The condition of these arteries renders them especially liable to rupture, with the consequent result of apoplexy and paralysis.
Treatment:—Remedies that will lower the blood-tension and decrease the force of the heart's action will tend to ameliorate the symptoms of this disorder. Troublesome symptoms depending upon it will be allayed also by heart sedatives carefully selected. When the vessels of the brain are not affected and there are no evidences of cerebral fulness, nitroglycerin will be beneficial often, but if there is a tendency toward cerebral hyperemia and vertigo or tinnitus aureum are present, this remedy must be avoided. It is wise to change the patient's habits of life and to subject him to conditions which are unusual but in every way agreeable. Changes in the diet exercise a most marked influence upon the condition and retard the appearance of any serious symptom. There is a consensus of opinion among writers in favor of the use of the potassium or sodium iodid in this condition. It is thought that they retard the deposits and tend to restore a normal condition of the arterial walls. The use of alcohol must be strictly prohibited and stimulating condiments with the food. The patient must be kept from active muscular effort, from anxiety, despondency or worry and from anger, and must reside in a low altitude.
