MANAGEMENT
The advice he should receive is well understood: to avoid physical efforts; to avoid mental tire; to avoid overeating or overdrinking of any foods or liquids; to reduce or abstain from alcohol, coffee, tea and tobacco, depending on what seems advisable in the individual case; to reduce the amount of meat eaten, especially if there is intestinal indigestion; to relieve intestinal indigestion; to cause free daily movements of the bowels; to abstain from any food which tends to cause gastric or intestinal flatulence; to abstain from such foods as contain nucleins, if the patient is gouty; to take frequent warm baths (not too hot) to promote the secretions and the circulation in the skin, and to take such daily exercise as seems advisable. If the patient cannot take exercise, simple calisthenics or massage should be instituted.
Whether nitroglycerin or other nitrite is advisable depends on the peripheral blood pressure. If the blood pressure is low, or not higher than is best for the patient, such treatment would be inadvisable. If, from the supposed cause, iodid seems to be indicated, it should be given in small doses and continued for some time. It is often wise, however, to give small doses, as 0.10 or 0.20 gm. (2 or 3 grains) once or twice in twenty-four hours, for a long period, to any patient who leas fibrosis or selerosis in any form. Iodid tends to prevent the progress of connective tissue formation. It is quite possible that some of its value is in activating a sluggish or imperfectly acting thyroid gland. If the patient is old, his thyroid is subinvoluting, and a little more of its activity will be of advantage. Many diseases which cause chronic myocarditis also cause, later, subactivity of the thyroid. Thyroid extract may be indicated if the patient is obese.
If, in spite of this management and treatment, the patient has cardiac asthma attacks, with or without pain, especially if there are pendent edemas, the question arises as to whether or not digitalis should be given. In such cases one cannot tell without trying whether digitalis will be of benefit or will cause more discomfort. 11 small dose of an active preparation should be given at first twice in twenty-four hours, and after a week once in twenty-four hours, its action being carefully watched and the decision as to whether the dose is too large or too small arrived at. It may do a great amount of good; it can cause increased cardiac pains. If used carefully and stopped when it appears not to be acting well, it will do no harm.
Chilling of the surface of the body should be avoided; sudden cold or sustained severe cold, which increases the contraction of the peripheral blood vessels and puts more strain on the heart muscle, is to be avoided if possible. More hours in bed at night and lying down after the heavier meals of the day will tend to give the heart the kind of rest it needs. Also complete rest for one day a week, or a rest of several days at a time, and a rest, both mental and physical, with such walking, golfing or riding as seems advisable, for at least one month every year, will prolong the lives of these patients, and may make an imperfect heart act well for months and years. If the patient is anemic he should, of course, receive some nonastringent iron; a. tablet of saccharated ferric oxid (Eisenzucker), in small doses, 0.20 gm. (3 grains), once or twice in twenty-four hours, is sufficient.
The prognosis of a case diagnosed as chronic myocarditis or chronic degeneration of the heart is doubtful, as one cannot tell until several weeks or months of observation whether this particular heart also has fatty degeneration or not. If there is fatty degeneration, the prognosis is bad. If there is no serious fatty degeneration, the patient, with the modified life outlined, may live for a long time. Acute dilatation from any serious strain on the heart may occur, and if there is fatty degeneration it is liable to occur at any time. Attacks of cardiac asthma are always serious, and always damage the heart a little more.