Structural diseases of the heart considered from the point of view of prognosis / by W.H. Broadbent.

  • Broadbent, W. H. (William Henry), Sir, 1835-1907.
Date:
[1891?]
Catalogue details

Licence: Public Domain Mark

Credit: Structural diseases of the heart considered from the point of view of prognosis / by W.H. Broadbent. Source: Wellcome Collection.

    12/50 (page 6)
    The sounds of the right ventricle undergo no modification of sufficient importance to require notice. Various symptoms are described as resulting from hyper- trophy of the heart—discomfort from the violence of the im- pulse, or actual pain in the region of the heart, tenderness on pressure in the neighbourhood of the apex, throbbing sensa- tions in the head and neck, pulsatile noises in the ears, or audible pulsation in the carotid and other arteries. The action of the heart may be unduly frequent, or too easily ex- cited, or abrupt and irritable, or irregular with falterings and bounds, which are very disturbing to the subject, and the heart may be prone to palpitation. There may be a sense of respiratory oppression, with sighing and desire to fill the chest with air. Some of the symptoms are simply the result of the size of the heart and of the vehemence of its beat; others are due, not to the hypertrophy itself, but to its cause, whether in the valves or in the vessels, or in external influences which have given rise to it; others, again, are common to various afiec- tions of the heart, functional or organic, besides hypertrophy. They have no such direct or definite bearing on prognosis as would warrant a discussion of their significance, though a sustained frequency of the pulse is an unfavourable sign. The question of prognosis in relation to hypertrophy mostly resolves itself into this: whether the compensation which it establishes is adequate and efficient, and how far it promises to be durable. The danger that the hypertrophy may go beyond the requirements of the occasion which has called for it does not, in my opinion, need consideration. Compensation is efficient when there are no symptoms of embarrassment of the circulation, and when the heart re- sponds to all ordinary calls upon it without undue shortness of breath or respiratory distress. The eff'ects of exertion are an important criterion, due allowance being made for the greater liability to breathlessness which is natural to some individuals, or is produced by bodily conformation or results from a sedentary mode of life. But the sounds of the heart usually give notice when it is overtaxed by the resistance to the onward movement of the blood. The interval between the first and second sound may be prolonged, the systole requiring more time than under ordinary circumstances to complete itself. So long as the normal proportion between the systolic and diastolic pauses is not disturbed there is no indication that the heart is un- equal to its work or is suffering from the stress put upon it: but when the systolic pause is lengthened at the expense of the diastolic, so that the sounds are equidistant, the period of repose and reconstitution of the muscular fibres of the ven- tricle is shortened, and their nutrition must in time sufier. During systole the blood is squeezed out of the walls of the heart, and it is during the diastolic relaxation that it obtains free access to the cardiac fibres. , x • * Another evidence that the heart is yielding to the strain of overwork is reduplication of the first sound. That is, as I have argued elsewhere, due to want of synchronism between the two ventricles in the act of contraction, or rather in arriving at that point in their contraction when their valves and tendinous cords and muscular walls are all made tense. This reduplication is at first very slight, the two sounds are senarated by the briefest possible interval, and are distinct one from the other only at one spot, just to the inner side of