38 Quain, loc. cit.
A rough guess at the proportional size of the heart may be made by comparing it with the closed right fist of the person. Weighing gives the most accurate test, and in each instance regard must be had to the size of the body. In some instances the organ has weighed only two or three ounces. The heart figured by Bramwell,39 one of the smallest on record, weighed only 2 ounces and 2 drachms. Quain40 refers to one, from a girl aged fourteen, which weighed only 1 ounce 14 drachms.
39 Diseases of the Heart, 1884.
40 Loc. cit.
Usually, in secondary atrophy, the visceral pericardium is wrinkled and the coronary arteries prominent and tortuous—two features of great importance in determining atrophy and in distinguishing between the acquired and congenital forms. The pericardial fat is variable in amount. Microscopically, brown atrophy is the most constant change; fatty degeneration much less common. Senile atrophy may present very similar appearances. The heart may be tough and firm from an increase in the fibrous elements. The pericardial fluid I have often noticed to be much increased.
There are no characteristic SYMPTOMS. The heart-muscle may be able to fulfil the requirements of the wasted frame. A feeble impulse and diminished area of dulness may be present, but in the marasmus of middle-aged or elderly people emphysema of the anterior margin of the lung may seriously interfere with a proper examination. The increased pericardial effusion occurs toward the end. The heart sounds are feeble and the pulse weak. Palpitation is frequent, and there may be the usual signs of anæmia, dizziness, etc.
The condition may be suspected, but is rarely diagnosed during life.
The PROGNOSIS depends upon the disease to which the atrophy is secondary, to the amelioration of which also the treatment must be directed.
Hypertrophy of the Heart.
DEFINITION.—An increase in the size of the heart due to an increased thickness, total or partial, of the muscular walls.