Examination Of The Heart Patient - General Procedure
( Originally Published 1921 )
IN deciding what constitutes a proper examination of a heart patient many considerations will modify the conclusion. The life insurance examination is merely intended to exclude heart disease, and is entirely negative in its operations. The examination of a person known to be suffering from heart trouble must of necessity be much more elaborate and undertaken from an entirely different point of view. The heart is known to be in trouble, and the point is to determine the nature of this trouble.
The interrogation of the person as to his sensations and what has happened to him is of course of vital importance, but does not pertain to the physical examination. This should be strictly technical and not influenced by any consideration except to determine the actual physical condition of the heart and the nature of its beat.
The old method of examination was by listening to the sounds of the heart and by determining its outline by percussion. Years of medical history and tons of literature have grown up about these methods, only to be superseded by the use of instruments of preci sion, except that it still remains necessary to recognize about ten characteristic murmurs. But even the detection of these might be dispensed with if the examination were otherwise complete.
Determination of the outline of the heart revealing the relative size and activity of the different chambers by the X-ray examination made under suitable rules gives a definite and recorded knowledge that far surpasses anything possible by percussion. The electrocardiogram gives us an autograph of the activities of the heart that reveals the functional condition of the organ in a manner that makes all other examinations in this direction unnecessary.
The study of the blood pressure as observed in the arm by the auscultatory method under varying pressures of the instrument gives a vast amount of information as to the condition of the general circulation. A stethoscope is used to listen to the sounds in the artery while pressure is made by the air bag of the machine for measuring the blood pressure.
The examination of the blood, particularly with reference to the number of red blood cells and the amount of coloring matter is an important thing in heart disease, because in young people, if the blood is not circulating properly, nature often makes an attempt to increase its oxygen-carrying power by making it much richer in the number of blood cells and in coloring matter than is normal. It is the haemoglobin that gives the color to the blood, and that absorbs the oxygen from the lungs and gives it up to the tissues at the same time that the blood circulates. When the haemoglobin contains a lot of oxygen, it is bright red, and when this oxygen has been used up, it approaches a bluish color. The high coloring and tendency to blueness of the lips so often seen in people with heart trouble is due to this change in the blood as well as to the fact that the blood is not circulating freely.
It is of much importance that heart patients should be examined to ascertain the actual diagnosis of their blood, because many of them are injudiciously overfed, and when they complain of a sense of weakness and the blood is thick, if they are put on restricted diet they immediately feel better and are able to be much livelier in their movements without distress.