Disturbances of the Heart / Discussion of the Treatment of the Heart in Its Various Disorders, With a Chapter on Blood Pressure

by Oliver T. Osborne

CLASSIFICATION OF CARDIAC DISTURBANCES

For the sake of discussing the therapy of cardiac disturbances in a logical sequence, they may be classified as follows:

Pericarditis
Acute
Adherent

Myocarditis
Acute
Chronic
Fatty

Endocarditis
Acute, simple malignant
Chronic
Valvular Lesions
Broken compensation
Cardiac drugs
Diet
Resort treatment
Cardiac disease in children
Cardiac disease in pregnancy
Coronary sclerosis
Angina pectoris
Pseudo-angina
Stokes-Adams disease
Arterial hypertension
Cardiovascular-renal disease
Arrhythmia
Auricular fibrillation
Bradycardia
Paroxysmal tachycardia
Hyperthyroidism
Toxic disturbances
Physiologic hypertrophies
Simple dilatation
Shock
Stomach dilatation
Anesthesia in heart disease

BLOOD PRESSURE

The study of the blood pressure has become a subject of great importance in the practice of medicine and surgery. No condition can be properly treated, no operation should be performed, and no prognosis is of value without a proper consideration of the sufficiency of the circulation, and the condition of the circulation cannot be properly estimated without an accurate estimate of the systolic and diastolic blood pressure. However perfectly the heart may act, it cannot properly circulate the blood without a normal tone of the blood vessels, both arteries and veins. Abnormal vasodilatation seriously interferes with the normal circulation, and causes venous congestion, abnormal increase in venous blood pressure, and the consequent danger of shock and death. Increased arterial tone or tonicity necessitates greater cardiac effort, to overcome the resistance, and hypertrophy of the heart must follow. This hypertrophy always occurs if the peripheral resistance is not suddenly too great or too rapidly acquired. In other words, if the peripheral resistance gradually increases, the left ventricle hypertrophies, and remains for a long time sufficient. If, from disease or disturbance in the lungs, the resistance in the pulmonary circulation is increased, the right ventricle hypertrophies to overcome it, and the circulation is sufficient as long as this ventricle is able to do the work. If either this pulmonary increased pressure or the systemic increased pressure persists or becomes too great, it is only a question of how many months, in the case of the right ventricle, and how many years, in the case of the left ventricle, the heart can stand the strain.

If the cause of the increased systemic tension is an arterial fibrosis, sooner or later the heart will become involved in this general condition, and a chronic myocarditis is likely to result. If, on the other hand, there is a continuous low systemic arterial blood pressure, the circulation is always more or less insufficient, nutrition is always imperfect, and the physical ability of the individual is below par. It is evident, therefore, that an abnormally high blood pressure is of serious import, its cause must be studied, and effort must be made to remove as far as possible the cause. On the other hand, a persistently low blood pressure may be of serious import, and always diminishes physical ability. If possible, the cause should be determined, and the condition improved.

No physician can now properly practice medicine without having a reliable apparatus for determining the blood pressure both in his office and at the bedside. It is not necessary to discuss here the various kinds of apparatus or what is essential in an apparatus for it to give a perfect reading. It may be stated that in determining the systolic and diastolic pressure in the peripheral arteries, the ordinary stethoscope is as efficient as any more elaborate auscultatory apparatus.

It is now generally agreed by all scientific clinicians that it is as essential—almost more essential—to determine the diastolic pressure as the systolic pressure; therefore the auscultatory method is the simplest, as well as one of the most accurate in determining these pressures. Of course it should be recognized that the systolic pressure thus obtained will generally be some millimeters above that obtained with the finger, perhaps the average being equivalent to about 5 mm. of mercury. The diastolic pressure will often range from 10 to 15 mm. below the reading obtained by other methods. Therefore, wider range of pressure is obtained by the auscultatory method than by other methods. This difference of 5 or more millimeters of systolic pressure between the auscultatory and the palpatory readings should be remembered when one is consulting books or articles printed more than two years ago, as many of these pressures were determined by the palpatory method.