Weber calls this case one of arteritis obliterans with intermittent claudication.
Pulmonary Artery
In the symptomatology of sclerosis of the pulmonary artery the clinical signs and symptoms are mostly referable to the obliterating endarteritis of the smaller vessels, while the physical signs are more apt to reveal the involvement of the main trunk. A history of severe infection in the past is frequent, especially smallpox, and accompanying aortic sclerosis with insufficiency of the mitral valve or stenosis of this valve is the rule. Striking cyanosis is an early symptom, while there is little if any dyspnea and edema. Intermittent dyspragia is common. There seems to be no tendency to clubbed fingers. Repeated hemorrhages from the lungs without the formation of infarcts may occur. There is usually an area of dullness at the upper left margin of the sternum and nearby parts, sensitive to pressure and to percussion, and the heart dullness extends unusually far towards the right. The diagnosis of the right ventricular hypertrophy may be substantiated by a fluoroscopic examination.
CHAPTER X.
DIAGNOSIS
Early Diagnosis
Arteriosclerosis is essentially a disease of middle life and old age. It is not unusual, however, to find evidences of the disease in persons in the third decade and even in the second decade. Hereditary influences play a most important rôle, syphilis and the abuse of alcohol in the family history are particularly momentous. The recognition of the early changes in the arteries among young persons depends largely upon how carefully these changes are looked for. The difference in the point of view of one man who finds many cases in the comparatively young, and another man who rarely finds such changes early in life, at times, depends upon the acuity of perception and observation and not upon the fact that one man has had a series of unusually young arteriosclerotic subjects. The diagnosis of arteriosclerosis may be so easily made that the tyro could not fail to make it. It is, however, the purpose of this volume to lay stress on the earliest possible diagnosis and, if possible, to point out how the diagnosis may be arrived at. It is obviously much to the advantage of the patient to know that certain changes are beginning in his arteries, which, if allowed to go on, will inevitably lead to one or more of the symptom groups described in the preceding chapters.
The combination of (1) hypertrophied heart, (2) increased blood pressure, (3) palpable arteries, and (4) ringing, accentuated second sound at the aortic cartilage is, in reality, the picture of advanced arteriosclerosis. If the individual is in good condition much may be done by judicious advice and treatment to ward off complications and prolong life with a considerable degree of comfort. But we should not wait until such signs are found before making a diagnosis and instituting treatment. As in all forms of chronic disease the early diagnosis is all important.