15 Revue de Medicine, 1883.
16 Virchow's Archiv, Bd. lxxxix.
17 Pathologische Anatomie, Lief. ii., 1884.
In the milder grades of fibrous myocarditis, when only the apices of the papillæ and thin layers beneath the endocardium are involved, the heart does not appear to be seriously affected; but when of any extent the vigor and force of the contractions are impaired, and the ventricle is unable to do the work of a healthy muscle. Compensatory hypertrophy is not readily established, possibly on account of the arterial sclerosis on which many of the cases seem to depend, although in rare instances, as in a specimen referred to by Quain,18 there may be very great muscular hypertrophy. Dilatation of the left ventricle is much more apt to follow, as the fibroid walls have not the resisting power of muscular tissue, and the patients finally present a clinical picture of heart failure. The gradual yielding of the fibroid region may result in aneurism.
18 "Lumleian Lectures," Lancet, 1872, i.
There are no characteristic symptoms to indicate the condition. The fibroid heart is a weak heart, and it is scarcely possible to distinguish it from fatty degeneration. A feeble, irregular, sometimes slow, pulse, dyspnoea on exertion, and painful anginoid attacks—symptoms which may have persisted for many years—are special clinical features in many cases. In a patient I examined some years ago for Palmer Howard of Montreal—a typical instance of the condition under consideration—the first symptoms began eight years before death with angina, and there were repeated attacks of cardiac asthma. A careful study of the case was made by Howard19 extending over several years, and weak heart, dyspnoea on exertion, and anginoid attacks were the prominent symptoms.
19 "Fibroid Disease of the Heart," Canada Med. and Surgical Journal, vol. viii., 1880.
Several very careful studies of the disease have been made within the past few years.20 Among the symptoms the following may be specially considered. The first place seems accorded by all to the cardiac weakness, and in consequence the pulse is feeble. By some (Rühle) irregularity is regarded as a special feature (delirium cordis), but Ebstein refers to three cases in which the pulse was always regular. Juhel-Renoy also speaks of it as frequent and regular. In many cases the number of beats appears about normal; in others there is a great increase; while in a third set the pulse may be very slow, sinking to 40 or 50 per minute. It is evident that in regard to regularity and frequency of the pulse there are very great differences. In this connection it is interesting to refer to the case of thrombosis of the coronary artery reported by Hammer,21 in which the pulse sank to 8 per minute.
20 Rühle, "Zur Diagnose der Myocarditis," Deutsches Archiv f. klin. Med., Bd. xxii.; Ebstein, Zeitschrift für klinische Medicin, Bd. vi.; Leyden, Ibid., Bd. viii.—a most important and exhaustive article; Welch, in a paper read before the Medical Section of the American Medical Association, Washington Meeting, 1884; Juhel-Renoy, Archives gén. de Médecine, Juillet, 1883.
21 Wiener Med. Wochenschrift, 1878, No. 5.