Functional And Organic Heart Disease
( Originally Published 1921 )
When a person's heart does not act as it should, he is said to have functional heart disease; when the heart is inflamed or deformed, it is called organic heart disease.
The heart may act poorly in several different ways. It may be irritable, so that it beats violently from slight causes ; or, it may be neither sluggish nor rapid, but the beats may be irregular, so that every little while a béat is missed; or there may be extra beats; or, a person may have functional heart disease and suffer great pain in the chest, in the arms, or the back. When the heart is disordered, as a rule the breathing, too, is affected, so that very few who have heart trouble escape the sensation of shortness of breath.
Organic heart disease may consist of inflammation of the heart with the formation of scars which deform the valves, just as a burn on the face causes a deformity of the face; or, it may consist of hardening of the muscles of the heart so that they can not do their work properly; or, the muscular tissue of the heart may become softened and stretched. All these affections are called organic diseases of the heart. What people know most about is valvular disease, tho, in fact, this is not serious to as many people as is the hardening or softening of the heart as a whole.
Enlargement of the heart is also an organic form of heart disease, and may consist of the stretching of which I have just spoken, or a thickening of the heart muscle called hypertrophy.
There is one form of functional heart disease that I have not mentioned, and that is a loss of tone in the heart muscle, and as I proceed I will show that this is important.
Heart disease develops in several different ways. It may develop suddenly through inflammation due to rheumatism or to some other form of infection; but most often it develops gradually through influences that exist in the body. The first sign of heart disease is usually shortness of breath which, of course, draws attention to the lungs and not to the heart at all.
In other cases, the person with heart disease notices the heart because it is beating too hard or because it seems to stop at times and then go ahead; or the first thing noticed may be an unaccountable attack of pain in the chest or in one of the arms.
'When a person has heart disease, there is ordinarily some change in the sounds of the heart that a trained ear can detect. This disease develops very slowly, and it can often be checked by proper management, particularly if the sufferer is intelligent and teachable.
The nurse must understand the nature of the diseases of the circulation and their effect upon the mind and upon the organs of the body, because it is only by a singleness of purpose founded upon knowledge that her perseverance can be maintained and a cure finally affected. The principles of the cure of these patients, once learned, will guide the nurse, tho the details may be varied from day to day.
Another reason why heart disease is a particularly interesting study for the nurse is that it represents in many cases that general breaking down of the constitution which results from many conditions of life as age advances. The heart, being the most active organ in the body, is the first to feel any extra burden of work orthe results of high living or of disease; and at the same time, it is more than any other organ dependent for its relief or restoration upon the general improvement of the whole body.
So in giving instructions to nurses, I refer, on the one hand, to disease of the heart as such; and on the other, to a general deterioration of the organs of circulation, which are found to include the heart, blood vessels, and kidneys, and to involve very closely the brain and digestive organs. In this connection, the nurse should know, once for all, that a heart murmur is not necessarily heart disease, and that heart disease is not necessarily accompanied by a murmur.
When a person has bad circulation, difficult breathing, swelling of legs, congestion, or pain, the cause of which is poor heart action, that patient has heart disease. When a person is free from these signs, he is not suffering from heart disease in the sense in which the subject is being here treated. An examination of the heart may show that the patient is specially liable to trouble, and hence should exercise particular care. It may, at the same time, inform the physician of the nature of the damage that the heart has suffered in previous attacks; but the mere existence of such changes does not constitute heart disease in its active form, such as is apt to fall under the care of the physician.