SYMPTOMS AND SIGNS
The symptoms of chronic myocardial degeneration are progressive weakness, slight at first, noticeable on exertion (and what was not considered exertion becomes such), as evidenced by slight palpitation, slight shortness of breath, leg weariness and mental tire. The heart frequently becomes more rapid, not only with exertion and change of position to the erect, but even after eating. Slight cardiac stimulants, as coffee, affect the heart more than previously; there is some sleeplessness, more or less troublesome, and more or less indigestion. There may be mental irritability and some mental deterioration, as shown in various ways. There are likely to be slight edemas of the lower extremities toward night. The amount of urine may diminish. A previously high blood pressure becomes lower. The pulse may be occasionally intermittent, and later actually irregular.
The physical signs often show an enlargement of the heart, with increased activity at first, from irritability of the heart and a lack of perfect coordination; later the heart may show typical signs of weakness. Not infrequently a heart suffering from fibrosis acts perfectly until some sudden exertion, as lifting, running or serious illness causes it suddenly to become weak. Such a heart rarely regains its former strength. This occurs frequently to those who have supposed themselves to be in perfect physical health. Some sudden strain which they have previously been able to endure without injury, such as carrying a weight upstairs, cranking a refractory engine, pumping up a series of tires, or walking rapidly with a younger or more active companion, will suddenly give cardiac distress signals, serious exhaustion and more or less lengthy prostration, perhaps for an hour or so, or perhaps for several days. Permanent cardiac weakness may follow, or compensation may again occur, to be more easily broken later. Slight cardiac pains and sensations referred to the cardiac region become frequent. Disliking to lie on the left side, when previously the patient has been able to sleep on this side without discomfort, is an evidence of cardiac disturbance. There may be no real pains, but the patient becomes conscious of his heart, perhaps for the first time in his life. This alone is an indication of coming trouble.
If these signs and symptoms develop late in life, or at any age with other symptoms of sclerosis or senility, little can be done therapeutically except to afford temporary relief and to prevent the occurrence of acute attacks of cardiac distress or dyspnea. If the disturbance is really due to chronic cardiac degeneration, the sooner the patient learns that his ability is restricted, that his life is narrowed, the better for his future.