Heart diseases head the list among all causes of death from disease. Furthermore, heart diseases are steadily on the increase. When this vital organ becomes affected it is time to take a complete inventory, not only of one’s physical condition in general and in detail, but of the various factors that make up one’s daily life.
One woman patient had been told by her doctor that she had a “bad heart” and was cautioned against doing any of the things that would have benefited her heart had it been somewhat abnormal. Yet fifteen physicians after this first one had told her, after careful examination, that her heart was normal. Still, she believed the first one, and in her own mind continued to have “heart trouble” and constantly worried about it. The worry did not cause a heart affection later, but it did make her a neurastheniac. However, if there is something definitely wrong with the heart anxiety and nervous conditions will have a detrimental effect upon it.
There are numerous well-defined diseases of the heart. Chronic organic diseases are those to be considered here. The acute conditions should have professional supervision, so do not need to be considered in this chapter. Functional disturbances usually are merely symptoms, resulting from causes outside of the heart and not due to structural changes in the heart tissues. These also will not be considered at present. It is the organic conditions that are most frequent and for which home treatment will be necessary for the most part, for it is a matter of months before chronic organic heart disease can be sufficiently improved that one may be considered wholly out of danger and before one’s life can return to comparative normal.
The organic diseases of a chronic nature in which we are most concerned are the chronic inflammations. If the pericardium or covering of the heart is affected, the condition is pericarditis; if the muscular walls are affected it is a myocarditis; if it is the heart lining, it is endocarditis, the most common heart affection. There also may be involvement of the arteries of the heart, as by a hardened or sclerotic condition with deposits of lime salts – the same as occurs in arteries anywhere else in the body in arteriosclerosis. Or the nerves of the heart may be affected, in which the beat is more or less altered.
The most common chronic organic affection of the heart is “leaking valves” – chronic valvular heart disease. There are four sets of valves in the heart and any set and any combination of sets of these valves may become abnormal. These valves arc subject to much wear and tear in their function of aiding in the circulation of the blood. Because of their position they are especially subject to any inflammation affecting the membrane that covers them – the “endocardium.”
These valves may be likened to the valves of a pump, which wear out before other parts of the pump and so require replacement. Unfortunately, however, there can be no replacement of the worn-out heart valves in man. Various changes may take place in the valves due to inflammation. Thus there may be a softening and disintegration, with breaking off or absorption of parts of the valves; or the valves may become adhered to the wall of the cavity; or excrescences may form on the margin of the valve; or the valve may curl up; or the heart cavity may dilate – any of these conditions preventing complete closing of the opening the valve was meant to guard, thus permitting blood to flow backward when it should be going forward, or preventing the onward flow of the blood.
The characteristic signs of valvular heart diseases are heart murmurs, which vary according to the valves affected; pain of varying degrees and nature, a rapid and weak pulse, shortness of breath, impaired circulation and blueness of the lips and extremities. These symptoms are much less pronounced when a person is reclining but become accentuated upon the slightest excitation. Fainting is likely to occur when the condition is more pronounced and the compensation of the heart-muscle is broken or defective. The natural termination of this condition is heart failure, though it may not occur for many years, during which time a reasonably active, productive, normal life may have been enjoyed.
One of the intermediate effects of this failure of the valve to close the opening is a backing up of the blood into the heart chamber just before the damaged valve, or into the lungs or some of the organs of the abdomen. If the blood is backed up into a chamber of the heart there is a gradual dilatation of this chamber. If the muscle tone is good the heart becomes merely hypertrophied, or enlarged; but if the muscle tone is weak there is an actual dilatation, due to the thinning of the muscle tissue. This is a precarious situation.
Because of the incompetence of the valve they have various common names for this type of heart trouble: organic heart disease, valvular disease of the heart, valvular regurgitation, cardiac insufficiency, valvular incompetency, stenosis, valvular leakage, chronic endocarditis, etc. Since the physician upon listening to the heart sounds can hear a “swish” of the blood as it regurgitates, it is said that the patient has a “murmur” in his heart.
Angina pectoris, usually regarded as a disease of the heart, is a painful and fearful affection. The pain varies in intensity, and the heart-action is more or less greatly disturbed. When the pain develops the patient fears to move and has an expression of great anxiety, for there is an associated feeling of impending death. The paroxysms may last for a few minutes only or they may continue for hours. Successive paroxysms are apt to increase in frequency. This condition is ascribed to sclerosis (hardening) of the coronary arteries – the arteries that feed the heart muscle – or to some other organic heart disease. After the age of forty-five is the most common time of the development of this disease.
The cause of heart disease may be considered as any factor aiding in the accumulation of poisons in the body. The toxic substances that would have been eliminated in the acute infectious disease, plus serums, vaccines and drugs are considered by many authorities to have an injurious effect upon the heart. At any rate, heart disease follows very frequently such diseases as rheumatism, diphtheria, scarlet fever, tonsillitis and venereal diseases. Many patients will date the beginning of their heart trouble from an acute ailment. This being so, the best way to avoid heart disease is to avoid acute illnesses.
But there are numerous other contributing causes of heart disease. Foci of infection in any part of the body, such as abscesses at tooth roots, or in the tonsils, or elsewhere, ulcerations, and other sources of pus in the body. The strain and the toxic influence of overeating is a frequent cause or at least a contributing factor. The injury to the heart from tobacco, alcohol, coffee, tea, coco beverages and the habitual use of drugs may seriously injure this vital organ. Frequent exposure to pronounced muscular fatigue and to cold, also sexual excesses and the hurry and worry incident to present day business life are among the causative factors.
Excessive physical exertion before maturity is a potent cause of heart disease. Undeveloped boys and girls who are obliged to work beyond their physical capacity may develop heart affections under the strain. There may not seem to be any serious manifestations of disease for a number of years, but the cause often is in the growing period of life. Men and women who were athletic in early life frequently have heart trouble, due to the fact that they have developed a large fibrous heart during their training days and then allowed the heart muscle to become atrophied and weak and replaced with fat through a later life of ease. At some later time they engage in some sport or activity, temporarily, feeling themselves to have their old-time strength, only to develop acute dilatation.
This indicates the inadvisability of attempting a sudden spurt of athletics without having ample reason to know that the heart and other vital organs can withstand the strain. It also indicates the importance of tapering off from athletics gradually, rather than suddenly, as so often is done after high school or college.
In the symptoms of heart disease there may be none definitely referable to the heart itself. Often the first trouble noticed is with the digestive system. Many people have heart disease and are not aware of it until they consult a physician for examination to determine the cause of shortness of breath. One patient, a woman of forty-eight, with two grown children, went to a physician for her insurance examination. She was found to have a valvular leakage, the cause of which, so far as could be determined, being scarlet fever at the age of nine, there having been no other condition to which it could be ascribed. When this woman was refused insurance she discovered why, and from that time on she began to have symptoms of heart disease.
Sometimes the first symptom noticed is a slight cough, probably streaks of blood in the sputum, which causes the patient to consult a physician for treatment for lung or bronchial trouble. It is the backing up of the circulation in the lungs and bronchial tubes which causes this cough, with possible rupture of some capillaries. Sometimes this backing up of the blood causes congestion in the digestive organs, resulting in indigestion. Practically every organ in the body may present symptoms due to this failure of the heart to accept full quantity of blood and pass it on normally. There also may be shortness of breath on slightest exertion; headache, ringing in the ears, dizziness and insomnia, circulatory defects, giving cold hands and feet, interference with the kidneys, shown either in the function of urinating or in the findings in the urine. The pulse at first may be strong and rapid, but later becomes rapid, weak and irregular, and there may be disturbing heart-symptoms. The lips may be pale or purplish; there may be pains or aches in the region of the heart, or extending to the left shoulder and down the arm (characteristic of angina pectoris). There may be gradual loss of weight and a gradually increasing weakness.
If compensation fails, due to gradual playing out of the heart muscle, a dropsical condition develops, which may affect the limbs and abdomen, though at first it may involve merely the tissues below the eyes or the eyelids.
Any of these symptoms may result from some other condition than heart trouble. If one experiences them, one should not immediately jump to the conclusion that one has heart disease. If due to heart disease most of such symptoms can be overcome or greatly alleviated.
It is well to have an examination made if there is a suspicion of heart trouble. It is my opinion that it is better for the majority of people to know whether such trouble exists, for there are certain things that they should do and others that they should not do if they want to preserve the heart.
It must not be expected that a valve can be restored to normal, but in many cases the muscular walls of the heart become stronger and thicker so that the heart is capable of pumping as much blood as before. As long as this condition remains there is compensation, and so long as this is maintained through proper care and treatment the patient will get along as well as before. But compensation is lost when the heart muscle weakens or the cavities dilate, and the symptoms of heart disease return.
Treatment. In order to secure satisfactory results in the treatment of organic heart disease it is necessary that the general bodily vigor be increased. One of the most important factors in the treatment is diet. It is important that the quantity of food be kept down to actual body requirements, and that the food be easily digested. Overloading the stomach can result only in continuation and aggravation of the heart trouble. Unless there is decided emaciation the diet should be quite abstemious. It is advisable in this case to weigh daily for a time, in order to determine the amount of food required to maintain the body at normal or somewhat below normal or to permit it to reduce slowly until it approaches nearer normal.
A complete fast is a very excellent treatment for this condition, but it should be of only short duration – from two or three to six or eight days, depending upon the general condition. If there is no dropsy it often is better to use the fruit diet instead of the absolute or water fast. If a complete fast is taken one should devote two or three days to the fruit diet when the fast is broken. The enema should be used daily during the fast or fruit diet if spontaneous elimination does not take place.
If there is no dropsical condition the milk diet is excellent in heart disease, but one should work up quite slowly to somewhat less than full quantity as the maximum allowance. Usually it is better to begin with one-half glass every hour (after the fast or fruit diet) and increase each day’s allowance an ounce or two at each feeding until three quarts daily are taken, then to increase a glass a day until four or a maximum of four and a half quarts are taken daily. The juice of an orange or two should precede the start on the milk each morning, and the enema should be used for elimination if necessary rather than to use any laxative food with the milk.
Instead of the milk diet one may use fair amounts of raw vegetable salads, cooked green vegetables, root vegetables, fresh and sweet fruit and sweet or any form of sour milk. Toast may be used also, but preferably not breads unless they are dry. No other cereal should be used for some time, relying upon the sweet fruit and milk for the carbohydrate requirement.
Exercise as well as diet is helpful in the treatment of chronic heart disease. The heart can be strengthened only by exercise. Its rhythmic beating is an exercise, but the heart would become quickly weakened if its owner were to lie in bed all of the time – even though it beat regularly during this time. The heart is composed practically entirely of muscle, and the only way it can be exercised is by sufficient exercise of the skeletal muscles to increase the force and frequency of the heart-beat. Naturally, all violent or straining exercise must be avoided. At first it may be necessary for a person only to practice some leg-raising and arm-raising movements while seated or while reclining, though it is not advisable to raise the arms over the head in most cases when the heart is seriously affected.
Walking is the most valuable type of exercise. When walking is begun one may gradually increase the distance covered, going at a slow gait at first. A furlong and back (or even less) once or twice a day may be sufficient for two or three days, then the distance may be increased one-half block each way daily. After considerable distance can be walked this way it is permissible to slightly increase the speed, or to select a very slight incline up which to walk for a number of steps. First the distance up the hill may be gradually increased and then slight increase in the speed. Then a slightly increased incline may be used; and so on, up gradually steeper inclines.
Usually there will be breathlessness, dizziness, blueness of the lips, palpitation or some other definite indication that the exercise has reached the limit of one’s heart endurance before the heart has been definitely damaged by the exercise, and when such symptoms develop one should cease exercise for that period and secure complete rest until recuperated. Some patients have been able to so increase the strength of the heart muscle that they could take a regular thirty-minute calisthenic exercise period or swim or play volley ball or go over trails up the hills without any symptom of heart affection. Such improvement has required many weeks, of course.
In addition to diet and exercise, the circulation should be aided by other means also. One should use the tonic bath daily. There is no better heart exercise of a perfectly safe type than this. The tonic bath is a bath at below body temperature. It may be at eighty degrees, seventy-five degrees, sixty-five degrees or on down, but it should be at such a temperature that, while it requires reaction, it does not produce a pronounced shock. One may ultimately become able to take a cold plunge, but this never is really necessary for the heart nor for any other organ or function of the body. The temperature of the water should be reduced gradually from day to day.
One of the best means of securing this tonic bath at first is by the wet-hand rub. The shower is satisfactory also, or one may use the splash method or a sponge or wet cloth. It is the reaction from the cold bath rather than the cold itself that secures better skin circulation to relieve the heart of some of its work, but the cold bath driving the blood inward and the reaction calling it out again, is a very excellent heart exercise through effect upon the nerves and blood vessels. If the reaction to cool or cold baths is poor it is better not to attempt this form of bath.
It may be necessary to bathe only one part of the body at a time at first and to use water very slightly below body temperature. But gradually more and more of the body and cooler and cooler water can be used.
Air-baths are excellent in this condition, and sun-baths also, though care must be taken to avoid sunburns. Any sunbath should be followed by a tonic bath to overcome the weakening effect of the infra-red rays, whether of natural or of artificial light.
It cannot be over-emphasized that exercise is necessary for correction of heart trouble. But also it must be equally stressed that over-exertion is dangerous and may be fatal. One should advance very slowly in muscular efforts. Also in the use of cold water. Many heart patients who previously have been denied exercise or activity of any kind will in time be enabled, by following the proper dietetic, exercise, bathing and resting program, to perform considerable amounts of activity, both physical and mental.