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Cardiac Hypertrophy.

Problems:

Synonym:—Enlargement of the heart.

Definition:—An organic change in the heart, characterized by an increase in the growth or development of the muscular fibers of the heart, which results in an actual enlargement of the entire organ. When this occurs without any enlargement of the chambers of the heart, which result from dilatation, the condition is known as simple hypertrophy. When with the increase in muscular tissue there is also a dilatation of the cavities of the heart it is known as eccentric hypertrophy, a condition in which the organ is usually much larger than in simple hypertrophy.

This abnormal growth may affect uniformly the entire structure of the heart (general hypertrophy), or it may affect one side of the heart, or one chamber of the heart only. A very rare condition may exist in which, from overgrowth of muscular structure, without dilatation, the chambers of the heart are reduced in size. This has been called concentric hypertrophy, though the term is seldom used and with many clinicians the existence of the condition is denied.

The enlargement of the heart occurs more frequently in the left ventricle, as an understanding of the exercise of its function would naturally suggest. Next in frequency is the right auricle.

Etiology:—The condition usually follows valvular disease of the heart, or other obstruction, to the arterial circulation, which results in overwork of the heart muscles, and in pericardial adhesions. Obstructions to free arterial circulation are a narrowing of the lumen of the aorta, aneurism, external compression, as from a tumor, and fibrosis. The condition is an accompaniment of chronic pulmonary disease also, such as emphysema and tuberculosis.

An idiopathic hypertrophy may be found present in men whose constant occupation demands great physical exercise or prolonged, violent muscular exertion, as woodmen, blacksmiths, teamsters, draymen and professional athletes. The excessive use of stimulating beverages, such as tea, coffee and alcoholic liquors, are common causes.

Symptomatology:—The symptoms of simple hypertrophy are those of increased and forcible heart action (sthenic heart). There may be at first no abnormal symptoms. This is especially true when there is sufficient compensation. Later, as the condition progresses, the force of the heart in its apex beat is conspicuous and produces some distress. The capillaries of the skin, especially those of the face, are very full, the face is flushed on every exertion and the eyes are slightly bulging; the pulsation of the carotids is plainly apparent, the pulse is hard, but not necessarily accelerated, is very full, bounding and resistant to pressure. These symptoms are followed by palpitation on exertion, persistent pain, although not necessarily severe in the precordial region, with vertigo, headache, tinnitus aurium and light flashes before the eyes.

This forcible condition of the circulation may rupture sclerosed vessels, resulting in cerebral, or pulmonary apoplexy, and in hemorrhage from the nose or from the lungs.

Where eccentric hypertrophy exists the sthenic symptoms are not so pronounced. There are evidences of valvular inefficiency, the pulse is feebler and more rapid, soft and more readily compressible. Later there is progressive debility, the difficult breathing is accompanied with cough, or actual bronchial catarrh, with short breathing, may be apparent. With the possible occurrence of hemorrhage from the lungs, under these circumstances, an erroneous diagnosis is likely to be made, but the correct condition is confirmed in the later stages by the appearance of cyanosis and general edema.

Treatment:—In the early stage of simple hypertrophy there is but little doubt that a gradual change in occupation and the use judiciously of certain of the heart sedatives will retard or control entirely the progress of the disease. The patient should positively refrain from stimulants of every kind and the exclusion for a limited time of nitrogen from the food will materially assist in preventing abnormal muscular development. Both aconite and veratrum will exercise an influence upon the heart muscle which will retard the development of the disease. Ergot will not only produce contraction of the capillaries within the organ itself, but it will prevent the cerebral symptoms and reduce nervous and high arterial tension. The use of small doses of the iodides in conjunction with full doses of the bromide of potassium, theoretically speaking, should be of much service. In the early stages of eccentric hypertrophy a careful adoption of the above measures and the use of gelsemium will be serviceable. It will be well also to study the specific heart remedies with reference to their exact adaptation to the conditions as they appear and to the specific indications.


The Eclectic Practice of Medicine with especial reference to The Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.



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