Rheumatism Of The Heart
( Originally Published 1921 )
Rheumatism of the heart is an affection to which every one is liable if he becomes subject to rheumatism in its acute form. It is a frequent cause of heart disease, and attacks particularly the young, tho it may attack people at any age. It is apt to cause injury to all parts of the heart and blood vessels.
In inflammatory rheumatism, when the heart is affected the whole organ is inflamed, tho often the valves and the surface of the heart are the only parts that show inflammation by symptoms or by subsequent injury. When the surface of the heart becomes inflamed, it is rough and causes a rasping sound that can be heard easily by the physician, and sometimes can be heard or felt by the patient. When the valves are first affected, the condition is often insidious, and if the person has rheumatic fever, it is difficult even for a physician who is observing the patient to be sure when it has begun.
In a person with rheumatic fever, when the pulse becomes rapid and the blood pressure quite low, also when the patient has vague pains around the heart, or palpitation, is short of breath on slight exertion, or has more fever than would be expected from the amount of inflammation in the joints, there is reason to believe there is heart disease; or when, after an --attack of rheumatic fever, the patient remains very pale and loses weight, the heart should receive attention.
It is the duty of the physician to examine the heart in all people who have rheumatism, and to repeat the examination at frequent intervals. The sound caused by the blood passing through the diseased valves is, of course, the most certain sign of rheumatic heart disease.
Rheumatic disease of the heart, particularly in a young person, is to be classed as a catastrophe than which none is worse, so far as the health is concerned. The damage to the heart is incurable in this sense: the shape of the valves can never be entirely restored, but health may be maintained in spite of this by a suitable regimen.
Another very important point is that the amount of damage can not be determined until long after the crisis of the illness has passed. It is necessary for people who have had rheumatic fever to be under treatment for a long time after they consider themselves well, being guided only by what the heart specialist tells them and what he advises.
All over the world there are chronic invalids who, perhaps, might have been saved to a fair degree of usefulness if they had followed the advice of an intelligent physician during the time of convalescence after an attack of rheumatism. There are many patients alive to-day with rheumatic heart disease who would long since have been dead had it not been for the repeated courses of treatment that have kept up the power of the heart to do its work, in spite of the handicap of rheumatic scars on the heart valves.
While bad living and mental overwork, in the form of worry, are frequently the causes of heart trouble in older people, rheumatism is the great cause in young people.
Classed with rheumatism, and of very much the same type, is the inflammation of the heart in scarlet fever, measles, typhoid, and other infectious diseases. But it is enough to have studied the type of disease caused by rheumatism.
A person attacked with rheumatism can help himself and his physician by an early appreciation of the seriousness of his disease, and no amount of self-sacrifice is wasted that prevents. the rheumatic patient from developing permanent injury to the heart.
The physician who makes light of any involvement of the heart whatsoever in rheumatism is unmindful of his responsibilities; and any patient who neglects care of this condition, after having its importance explained to him, is guilty of recklessness.
The nurse will be put to the utmost of her patience in keeping young people quiet for the length of time that is required for the safety of the heart after rheumatism. During the illness, the nursing is much the same as in any severe fever. There is usually but little danger from the heart at the time, but the nurse should have in mind the future in order to prevent permanent damage by persuading the patient to wait quietly until a safe time for leaving the bed.