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Chronic Myocarditis.

Problems:

Synonyms:—Fibrous myocarditis; fibroid heart; chronic interstitial myocarditis.

Definition:—Slowly developing structural change in the cardiac interstitial tissue, fibroid in character, inducing ultimate induration.

In this disease there is a replacement of the muscular fibers of the heart by fibrous tissue. The condition results from an inflammation of the small arteries of the heart, resulting in obliteration and diminished blood supply, which at first causes atrophy, more or less complete, of the muscular fibers, and these, as stated, are substituted by fibrous tissue.

Etiology:—These chronic changes result often from or follow the changes that have been induced by an acute pericarditis or endocarditis. They also follow chronic rheumatism, gout and chronic nephritis, prolonged malarial poisoning, diabetes, syphilis and lead poisoning and the influence of other irritating substances, which induce arterial sclerosis. Probably the commonest cause, however, is chronic alcoholism and the use of tobacco.

Symptomatology:—There are no characteristic symptoms or strictly pathognomonic evidences of the chronic form of this disease. Classic cases have been found on post-mortem examination which were not detected during life. Usually, however, it is attended with three phenomena—a characteristic slow pulse, which may beat forty or forty-five beats per minute (brachycardia); angina pectoris, and vertigo and syncope, with pseudo-apoplectic seizures. The other evidences closely resemble those of fatty degeneration of the heart. Early in the history of this disease there is a sensation of constriction and weight in the precordial region, there is palpitation upon the least exertion and slightly oppressed breathing, which later may become markedly asthmatic, with symptoms of passive congestion of the kidneys and liver; ultimately dropsy may appear, the patient is easily fatigued and avoids exertion. The mental functions are inclined to inactivity and the mind may become dull, the patient forgetful, absent minded and without power of mental concentration. Upon examination of the chest it will be observed that there is slightly labored respiration, that the impulse of the heart is heaving or lifting in character, and slightly displaced downward and to the left in its apex beat. The sounds are muffled and the first and second beat are without apparent distinction in character. There is no great degree of hypertrophy.

Prognosis:—The condition ultimately is fatal. It may be greatly prolonged, however, in cases where the cause is of slow development. In other cases death is of sudden occurrence when serious disease of the heart had not been apprehended.

Treatment:—No specific measures can be suggested. The course of life and the care of the patient and the surroundings should be advised, as in the treatment of any form of chronic progressive degenerative heart disease. It is in cases that show the characteristic phenomena of this form of disease that crataegus oxyacanthus has been used with good results. It is like cactus, is a nutritional remedy, and improvement of the nutrition of the heart is greatly to be desired. We believe that a long continued use of these remedies, combined with hydrastis canadensis, which improves the tonus of the capillary circulation of the heart, and collinsonia will at least greatly retard the advancement of this and other forms of degenerative heart trouble. The use of agents that improve the character of the blood and increase its oxygen carrying power is most important. These are iron and nux vomica, with avena sativa, through its influence on the nerve centers, when there is general debility. The patient should reside in an equable climate, devoid of abrupt changes and where the atmosphere contains the largest possible percentage of oxygen. In fact, the inhalation of oxygen in reasonable quantity occasionally will be beneficial. The patient must avoid over-exertion of both mind and body, as well as anxiety and worry, and must attend faithfully to the carrying out of a careful and judiciously selected course of diet. There are systematic courses of exercise, muscular movement or massage laid out by certain specialists which have for their object the removal of all obstruction to the return of the venous blood to the heart and the promotion of free circulation in the arterial capillaries. This has been productive of marked benefit in a number of cases of chronic heart disease, as it at once takes the strain off the heart muscle, and from increased freedom of the circulation promotes a more normal heart action. But these exercises should be conducted with great care in advanced cases.


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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