MISCELLANEOUS DISTURBANCES
SIMPLE HYPERTROPHY
Like any other muscular tissue, the heart hypertrophies when it has more work to do, provided this work is gradually increased and the heart is not strained by sudden exertion. To hypertrophy properly the heart must go into training. This training is necessary in valvular lesions after acute endocarditis or myocarditis, and is the reason that the return to work must be so carefully graduated. When the heart is hypertrophied sufficiently and compensation is perfect, a reserve power must be developed by such exercise as represented by the Nauheim, Oertel or Schott methods. Anything that increases the peripheral resistance causes the left ventricle to hypertrophy. Anything that increases the resistance in the lungs causes the right ventricle to hypertrophy. The right ventricle hypertrophy caused by mitral lesions has already been sufficiently discussed. The right ventricle also hypertrophies in emphysema, after repeated or prolonged asthma attacks, perhaps generally in neglected pleurisies with effusion, in certain kinds of tuberculosis, and whenever there is increased resistance in the lung tissue or in the chest cavity.
The term "simple hypertrophy" is generally restricted to hypertrophy of the left ventricle without any cardiac excuse—the hypertrophy by hypertension and hard physical labor. It is well recognized that it hypertrophies with hypertension and with chronic interstitial nephritis. It also becomes hypertrophied when the subject drinks largely of liquid—water or beer—and overloads his blood vessels and increases the work the heart must do. This kind of hypertrophy develops slowly because the resistance in the circulation is gradual or intermittent. In athletes and in soldiers who are required to march long distances, hypertrophy generally occurs. This hypertrophy, if slowly developed by gradual, careful training, is normal and compensatory. In effort too long sustained, especially in those untrained in that kind of effort, and even in the trained if the effort is too long continued, the left ventricle will become dilated and the usual symptoms of that condition occur. Such dilatation is always more or less serious. It may be completely recovered from, and it may not be. Therefore it proper understanding of the physics of the circulation by the medical trainer of young men to decide whether or not one should compete in a prolonged effort, as a rowing race, for instance, is essential. It is wrong for any young athlete to have an incurable condition occur from competition.
Sometimes simple hypertrophy of the left ventricle occurs from various kinds of conditions that increase the peripheral circulation. It may occur from oversmoking, from the mertisc of coffee aid tea, from certain kinds of physical labor, or from high tension mental work. It is a part of the story of hypertension. Many times such patients, as well as occasionally trained athletes, and sometimes patients with arteriosclerosis or chronic interstitial nephritis complain of unpleasant throbbing sensations of the heart added to these sensations are a feeling of fulness in the head, flushing of the face, and possibly dizziness—all symptoms not only of hypertension but of too great cardiac activity. Various drugs used to stimulate the heart may cause this condition; when digitalis is given and is not indicated or is given in overdosage, these symptoms occur.
The treatment is simply to lower the diet, cause catharsis, give hot baths, stop the tobacco, tea and coffee, stop the drinking of large amounts of liquid at any one time, and administer bromids and perhaps nitroglycerin, when all the symptoms of simple hypertrophy will, temporarily at least, disappear.
If the heart is enlarged from hypertrophy, if it is the right ventricle that is the most hypertrophied, the apex is not only pushed to the left, but the beat may be rather diffuse, as the enlarged right ventricle will prevent the apex from acting close to the surface of the chest. If the left ventricle is the most hypertrophied, the apex is also to the left, but the impact is very decided and the aortic closure is accentuated.