Inflammation Of The Heart
( Originally Published 1921 )
The heart, like any other part of the body, is liable to inflammation, and the inflammation may be acute, coming on suddenly and with severity ; or it may be chronic, running a slow and tedious course.
Acute inflammation of the heart occurs most often in inflammatory rheumatism, but occasionally happens in connection with other infectious diseases, such as pneumonia, scarlet fever, measles, and diphtheria. Strangely enough, it is quite often seen in connection with St. Vitus's dance in children.
Chronic inflammation of the heart often originates in an attack of typhoid fever, grippe, or some form of poisoning. A good many cases arise from poisoning of the system through defective action in the digestive organs. This slow inflammation may cause a certain hardening of the heart muscle that is followed by marked irregularities of the heart. Chronic inflammation also occurs in kidney disease.
In acute inflammation of the heart, as is seen typically in a young person with inflammatory rheumatism, the whole heart is inflamed the muscle, the valves, the covering and lining of the heart, and even the harder connective tissue. The result is that the machinery of the heart, as well as its power of action, is damaged, and when the inflammation subsides, scars are left that later on cause deformity of the valve, just as a burn on the surface of the body may cause a deformity. This is the origin of most cases of valvular disease.
Chronic inflammation of the heart is different in its action. It generally involves the muscle and connective tissue, and is not so apt to affect the valves as when it is a continuation of an acute inflammation.
When a person has inflammation of the heart, there is often pain and tenderness over the heart. The heart action becomes rapid, and there is extreme shortness of breath after exertion. When it occurs in rheumatism, there is usually a considerable increase in fever. When the valves become swollen they may not close properly; and on listening to the beat, the blood may be heard leaking through the valves when they are closed and normally should not allow the blood to pass.
However, acute inflammation of the heart, when it occurs in the course of other diseases, does not give as much trouble as its future importance would suggest, and very often the patient must take the physician's word that the heart has been inflamed, and submit to the proper treatment in spite of the absence of conscious symptoms.
This makes the care of acute heart disease a matter of great anxiety to physicians, because it is difficult to get people who have had. rheumatism or other infectious diseases to believe when they feel perfectly well that they must remain quiet for a long time on account of this inflammation. I remember a young nurse who had rheumatism when I first was in the hospital. She would not remain in bed after her pains left, and one day soon afterward, she noticed that she was short of breath, and on examination her heart was found to be very much injured.
In the case of children who have inflammation of the heart it is particularly important that they should have a long course of treatment in bed, because whatever injury remains (and some is quite certain to remain) will be carried with the child through life, and a little deformity of the valves may make the difference between years of usefulness and years of invalidism.
The work of the heart is, in a measure, proportionate to the amount of physical exercise that a person takes, and the only way that the heart can be rested is by resting the whole body. It is bad enough that the inflamed heart must keep on pumping without imposing on. it additional burdens while it is trying to recover from inflammation.
Chronic inflammation often starts, as I have already said, in an attack. of typhoid fever, grippe, or some other form of poisoning, and runs the whole first part of its course without showing symptoms. It is always to be suspected when the heart is irregular in its beats, and the beats are irregular in force. If the cause of it is known, that should receive first attention. Then the disease itself should be treated. When intestinal fermentation is known to exist, as shown by the appearance of indican in the urine and perhaps a history of intestinal indigestion, it is of the utmost importance that the diet be regulated and that certain remedies be taken to cure this condition.
Inflammation of the heart often leads to an attack of pain in the chest. This pain in its severest form is called angina pectoris, tho it is hard to say just when it is bad enough to be called by this name. Weakness of the heart muscle is always suggested by attacks of pain around the heart or down the left arm, and there are often tender spots in various parts of the chest. Of course, if inflammation has done injury enough to impair the heart's action, there is defective circulation, as shown by shortness of breath, swelling of the feet, and tenderness over the liver.
Both acute and chronic inflammation of the heart call for careful management over a considerable period of time, and the patient is lucky indeed if there is not damage left that will always demand care.
The care in cases of acute inflammation of the heart is the same as that of any severely ill patient, but usually of greater importance. The temperature is apt to run high; when this occurs, it can be reduced by sponging, even tho the inflammation of the heart may be acute. The application of ice-bags over the heart is often advantageous in quieting its action and relieving pain. The patient must under no circumstances be allowed to make any exertion. This constitutes one of the most difficult points in the nursing, because complete rest must be carried out for a long time after the patient feels perfectly well.
In chronic inflammation of the heart, accompanied by weakness, patients are liable to attacks of severe exhaustion, and the nurse must enforce limitation of exercise.