Gradual Heart Failure
( Originally Published 1921 )
In gradual heart failure, which is more common than sudden heart failure, the signs creep on slowly. The heart, which has usually been diseased or overburdened before there are any conscious symptoms, gradually loses its power to circulate the blood, and, as a result, the blood stagnates in some part of the body and causes distress. There may be a general want of circulation, but it is first noticed when an active circulation is needed for some special reason.
If a person who has undergone gradual heart failure attempts to go upstairs, shortness of breath is experienced, and, after a while, the feet become swollen and the liver becomes congested. Indeed, the first attack of a person with a failing heart is often supposed to be an at-_ tack of indigestion. Such attacks usually come on after a heavy meal there is an accumulation of gas in the stomach, and the heart becomes irregular and feeble. These attacks are usually regarded as having their origin in the stomach; but if the heart had not been feeble they would not have occurred, and they cease as soon as the heart is properly treated. These attacks are not without danger, as is proved by the sudden death with such symptoms of one or two men of prominence every year after public dinners.
When the heart fails, it habitually loses its tone and becomes dilated; dilatation usually causes pain. This pain often is over the point of the heart itself under the left breast, or it may be felt under the breast bone, or referred to any part of the chest. Occasionally this pain is severe and not far removed from true angina pectoris.
When gradual failure of the heart is suspected, the three things to be looked for are shortness of breath, tenderness on pressure over the liver, and swelling of the feet. When these three are absent, whatever may be the trouble with the heart otherwise, it is not heart failure.
The treatment of gradual failure of the heart is coextensive with the treatment of heart disease in general. Most appropriate hygienic measures take the form of baths, exercise, regulation of food and limitation of labor.
A person who suspects a weakness of the heart should especially avoid muscular strain and mental excitement, because the danger to be feared is that the failure may become acute. These measures must be judiciously accompanied by rest and correction of bad habits as to alcohol, tobacco, and food. Sleep must be attended to and the bowels regulated. The nurse should constantly bear in mind that it is her duty to observe the breathing of the patient and compare it with the patient's previous condition. She should particularly note any irregularity of breathing when the patient is asleep. When bathing her patient the nurse should ascertain whether there is any tenderness on the right side of the body, just below the ribs, and should note any swelling of the feet or other parts of the body. However careful a physician may be, he can not, in the nature of things, examine a patient with the same attention to detail as the nurse.
On the other hand, the nurse must not let the patient become aware that she is looking for signs of gradual heart failure, and must learn in every way to encourage the patient. Fortunately, the heart is situated above the diaphragm, and, according to ancient tradition, diseases above the diaphragm are characterized by hopefulness while those below the diaphragm lead to depression of spirits. The real heart patient is always hopeful and has courage beyond that of other people. Hardening of the arteries causes depression of spirits.
The nurse should help, through the education of her patient, to meet conditions in the best possible way. As a heart specialist I admit that the greatest success I have ever had in the cure of persons with serious heart affections has been, in great measure, dependent upon the loyal cooperation of a good nurse or of faithful members of the patient's family.