Simple Enlargement Of The Left Ventricle

This is sometimes found to exist after death, when no reason can be discovered why it should exist, and is supposed to be caused by physical exertion, giving the heart too great an amount of work. A runner, for example, we may suppose to keep his heart beating with a degree of force and frequency beyond what is natural for the greater part of the day; and that perhaps, for many days or weeks together.

We ascertain its existence, when it does exist, first, by the account which the patient gives of himself. He has a sensation of beating of his heart, which he ought not to have; he feels it and hears it beating as he lies awake in bed; or even at other times when he is at rest. The pulsations are regular. The breath may be short, but there is no feeling of suffocation; there is seldom any dropsy; the pulse is full and strong; the face is florid; the patient is liable to headache, to bleeding from the nose, to active haemorrhage,, and to local inflammation. If you place your hand upon the left breast, you find the heart is beating with a strong, steady impulse; and sometimes that side of the chest is plainly bulging and prominent. This condition is occasionally seen in young men who devote themselves in excess to "athletic sports."

These cases require perfect tranquility of mind and body, moderation in diet and bodily exercise, small local bleedings by means of leeches, frequently repeated, with close attention to the state of the digestive organs.

Simple enlargement of the right ventricle is not a common disease. When it occurs, it results from some actual or virtual impediment to the passage of the blood from the ventricle into the lungs.

One reason why Disease of the Heart was formerly overlooked is said to be that the natural dimensions and relative proportions of that organ were not ascertained or much attended to. Bouillard, who has taken much pains with this matter, weighing and measuring a great number of different hearts, states that the mean weight of that organ, with the origin of the large vessels, and empty of blood,in adults from 25 to 60 years old, is from eight to nine ounces; that in subjects from 15 to 25 years old it may be one or two ounces less; and that in very large and robust persons, it may rise to ten or eleven ounces. Also that the weight is less in women than in men.

Palpitation and irregular action. We are not, in general, sensible of the beating of our hearts, but when the pulsations become more than ordinarily forcible, they make themselves felt, and the sensation is, in many cases, a most troublesome and distressing one. Palpitation implies increased force, or increased frequency,-or an increase both in force and frequency-of the contractions of the heart. Every one has experienced palpitation in his own person who has run himself out of breath. Irregular action of the heart consists in some derangement or discord of its movements, and is discovered by the condition of the arterial pulse, by unnatural fluctuations in the strength, or in the number of its beatings, or both. Sometimes a few rapid and feeble pulsations occur at uncertain intervals, and are followed by others that are fuller and slower. Sometimes one or more beats are left out, and the next beat, as if to make up for this pause, is unusually strong. The pulse is then said to intermit. The intermissions may be unperceived by the patient himself; but often they are attended with a singularly disagreeable fluttering or trembling sensation in the breast.

Now any of these deviations from the natural action of the heart alarm people very much,and impress them with the belief that they have some fixed disease of that organ; and although with these symptoms there may sometimes be organic disease, in most cases it is otherwise. Palpitation of the heart, and intermission or irregularity of the pulse, are often dependent upon some disordered condition of the stomach, and will cease at once when that condition is rectified. Sir Thomas Watson mentions a case of this kind: "A friend of mine, a barrister, used to be very anxious about himself, because a fluttering sensation frequently occurred at his heart; an intermission of one or two beats, and then a violent throb when the organ again resumed its play. This is a sensation very familiar to my own consciousness, and probably most persons have occasionally experienced it. However, it happened so often to the gentleman I speak of, that it made him very unhappy. He persuaded himself that he had Disease of the Heart, and that he should some day suddenly drop down dead. But there was no other symptom of cardiac disease, direct or indirect, general or physical. He was accordingly told that the intermission depended upon some fault in his digestive organs; and he was advised to leave off different articles of food and drink in succession, in order to discover whether any one particular thing offended the stomach, and gave rise to the symptom. He began by abstaining from Tea, of which he had been in the habit of drinking a large quantity; and thereupon the fluttering of the heart ceased. After a while he took to Tea again, and the fluttering returned. He repeated the experiment many times, and always with the same result, till at length his mind was satisfied; and by renouncing Tea altogether, he got rid of his palpitations and his apprehensions. I mention this instance, because it came within my own cognizance; but it is only a sample of many such, and Tea is frequently found to be the disturbing agent."

It must not always be taken for granted, however, that the heart is free from disease because its irregular movements are accompanied by dyspeptic symptoms, as disease of that organ is very apt to derange the digestive functions.

Again, there are palpitations of a purely nervous character, which depend upon a peculiar and highly sensitive condition of the nervous system. Persons of a "movable" constitution, whether male or female, are subject to these palpitations; but especially young women: and of these, such as are pale, hysterical, in whom the menstrual functions are deficient, or excessive, or somehow unnatural. Nervous palpitations are apt to come on when the patient is quite at rest; palpitations that result from disease of the heart are, on the contrary, mitigated by repose. The occurrence of palpitation in the night, however, might result from either cause, for nervous persons who dream, awake often with palpitation; and the recumbent posture is apt to excite or to aggravate the palpitations that are organic. Irregularities of the pulse are sometimes the consequence of excessive smoking, and also of over-working the brains.