If a pregnant woman is known to have a degenerative condition of the myocardium, or arteriosclerosis, the danger from the pregnancy is serious, and the pregnancy should rarely be allowed to continue.
Even if no serious symptoms occur during the term of the pregnancy, and the heart continues to compensate sufficiently for its defect, labor should never be allowed to be prolonged. The tension thrown on the heart during labor is always severe, and has not infrequently caused acute heart failure by causing acute dilatation, and in these damaged hearts tediousness and severe, intense exertion should not be allowed. Proper anesthetics and proper instrumentation should be inaugurated early.
Patients who have successfully passed through the danger of pregnancy with cardiac lesions, possibly relieved by radical treatments, should be warned against ever again becoming pregnant. If this warning does not prevent future pregnancies, the family physician and his consultant must decide just what it is proper to do. It is to be understood that no uterus should ever be emptied until one or more consultants have approved of such treatment.
Sometimes serious heart weakness develops during the later weeks of pregnancy, requiring the patient to remain in bed and receive every advantage which rest, proper care and well judged medicinal treatment will give the circulation.
If the heart is weak and there have been signs of myocardial weakness or loss of compensation, the sudden loss of abdominal pressure after delivery may allow the blood vessels of the abdomen to become so overfilled as to cause serious cerebral anemia and cardiac paralysis. Therefore in such cases a tight bandage must immediately be applied, and it has even been suggested that a weight, as a bag of sand weighing several pounds, be placed temporarily on the abdomen. The greatest possible care should be given these women during and after labor.
Acute dilatation is not an infrequent cause of death during ordinary labor, and is more apt to occur in these cardiac patients. If signs of acute dilatation of the heart occur, with associated pulmonary edema, venesection (especially if there has not been much uterine hemorrhage), with the coincident intramuscular injection of one or two syringefuls of aseptic ergot, will often be found to be life- saving treatment. Septic infections after parturition are prone to cause endocarditis and myocarditis, and a malignant endocarditis may develop from uterine infection or uterine putridity.
DEGENERATIONS
CORONARY SCLEROSIS
While disease of the coronary arteries may occur without general arteriosclerosis, it is so frequently associated with it that it is necessary to give a brief description of the general disease. Arteriosclerosis or arteriocapillary fibrosis is really a physiologic process naturally accompanying old age, of which it is a part or the cause, and it should be considered a pathologic condition only when it occurs prematurely. It may, however, occur at almost any age after 30, and is beginning to be frequent between 40 and 50. In rare instances it may occur between 20 and 30, and even in childhood and youth. It is much more frequent in men than in women. Its most common cause is hypertension; in fact, hypertension generally precedes it. The most frequent cause of hypertension today is the strenuousness of life, the next most frequent cause being the toxins circulating in the blood from overeating, overdrinking, overuse of tobacco and the overuse of caffein in the form of coffee, tea or caffein drinks. Another common cause of arteriosclerosis occurring too early is the occurrence of some serious infection in a person, typhoid fever and sepsis being most frequent. Syphilis is a frequent cause, especially of that form of arteriosclerosis which shows the greatest amount of disease in the aorta. Mercury used in the treatment of syphilis is more liable, however, than syphilis to be the cause of arteriosclerosis. Although this drug, even with the arsenic injections now in vogue, is necessary for the cure of syphilis, it probably tends to raise the blood pressure by irritating the kidneys and by diminishing the thyroid secretion, both of these occurrences predisposing to arteriosclerosis. From the fact that lead poisoning causes an increased blood pressure, lead is a probable cause of arteriosclerosis. With the greater knowledge of the danger of poisoning possessed by those who work in lead, chronic lead poisoning is becoming rare, as evidenced by the lessening frequency of wrist drop and lead colic.
Chronic nephritis is often a coincident disease, but the causes of the arteriosclerosis and the nephritis are generally the same. Alcohol, except as a part of overeating and as a disturber of the digestion, is perhaps not a direct cause of arteriosclerosis, as alcohol is a vasodilator. Hard physical labor and severe athletic work may cause arteriosclerosis to develop, and it is liable to develop in the arteries of the parts most used.