Heart failure

“ More, too, must be done to help survivors of initial heart attacks live full lives. Within six years of a heart attack, for instance, more than a third of those afflicted develop severe and often disabling chest pain. One-fourth or more of them will have another heart attack, and another fifth suffer heart failure. The challenges posed by heart disease are becoming ever more pressing as America ages and more of us live beyond age 65-the group most affected by this disease. ”

“ When large numbers of these cases were studied, it was found that they always last more than ten years, and, while heart failure in such cases is reported, it is doubtful if this occurs with more frequency in these patients as the result of strong reflexes than in the general run of patients, for it must not be forgotten that there is a certain average number of deaths from so-called heart failure in people supposed to be in good health. ”

“ TREATMENT The condition may be stopped by relieving the heart and circulation of all possible toxins and irritants, and by the administration of digitalis. One attack is frequently followed by others, perhaps of longer duration. Occasionally, however, the patient may be observed for many years without the condition again being present. If the pulse, in spite of treatment, is permanently irregular, and auricular insufficiency is permanent, the patient is of course in danger of cardiac failure; but still he may live for years and die of some other cause than heart failure. ”

“ In all cases of bloody, serous, purulent, or aërial effusions into the pericardium, that present dangerous symptoms of heart failure, operative interference should be undertaken as soon as it is evident that medication is not lessening the embarrassment of the central organ of circulation. ”

“ Heart Failure:—"In cases of cardiac weakness, the thing needed is not simply an increased rate of movement of the heart, or an increased volume of the pulse, but an increased movement of the blood current throughout the entire system. In the application of any agent for the purpose of affording relief in a condition of this kind, the peripheral heart as well as the central organ must be taken into consideration. In fact, the whole circulatory system must be regarded as one. The heart and the arteries are composed of essentially the same kind of tissue, and have practically the same functions. ”

“ Life has been saved in this kind of sudden acute cardiac failure in valvular disease. When venesection is not indicated in certain conditions of low blood pressure and heart failure, ergot has saved life. It causes contraction of the blood vessels and seems to tone the heart. ”

“ Heart failure, one of the most frequent causes of death in people of adult and advanced years, is often due to fatty degeneration, and a patient who suffers from alcoholic degeneration necessarily runs a much greater risk of heart failure during the course of acute fevers or from overwork, exhaustion, and an overloaded stomach, and the like, than does the man with a strong, healthy heart unaffected by alcohol or similar poisons. ”

“ If the cause of the death had been heart failure, I should have been more sanguine. Heart failure may always be translated as the inability of the local G.P. to discover what his patient really did die of, but a hæmorrhage seems fairly definite. ”

“ An exact prognosis of this inflammation is impossible. We do not know how far an acute myocarditis may progress and entire recovery take place; we do not know how slight a myocarditis may cause serious symptoms. Clinically we know that many patients after serious illness never again have perfect circulatory strength. Other patients almost die of heart failure and yet apparently absolutely recover their ability to do hard physical work. ”

“ Patients with acute heart failure or acute loss of compensation, with more or less serious edemas, should rarely take the risk of traveling any distance to be treated at an institution. As a general rule they are better treated for a few weeks or months at home. ”

“ A normally-sized heart with irregularity, increased frequency, and a variable systolic murmur in the mitral area, is characteristic of tobacco poisoning. A heart enlarged on both sides, and acting irregularly without murmur, is (apart from cardiac failure) suggestive of strain in early life.
Cardiac symptoms taken individually are of less diagnostic value than signs. No symptom is pathognomonic. Palpitation is a nearly universal phenomenon of cardiac disease and disorder. Faintness and actual faints are not uncommon in cases of early cardiac strain, gouty heart, and nervous disturbances. ”

“ In addition to extrinsic dangers, particularly those of Bright's disease, cerebral thrombosis and hæmorrhage, and bronchitis, failure of the heart is liable to supervene and prove fatal from the gravest of all intrinsic causes, namely, coronary degeneration. As this increases, the myocardium is steadily more and more impoverished ”

“ Cardiac failure accounts for most of the deaths, whether developed gradually with dropsy, which proves to be intractable; or progressing rapidly with great cardiac distress, including angina; or occurring suddenly, as it often does. Aneurysm makes its appearance in other instances, of which the patient dies, or he is carried off by general paralysis or Bright's disease.
What prospect have we to hold out to the man who has strained the walls of his heart by muscular effort? ”

“ But an equally potent cause of heart failure is its depletion by the simultaneous stagnation of the blood mass in the veins of the abdomen. Finally, to complete the mischief, we have not only anæmia of the semi-paralytic oblongata, but the scanty blood supply this important centre receives becomes also surcharged with carbonic acid. ”

“ You see, she has heart disease, and any sudden shock brings on one of these terrible attacks that may kill her. She bears everything like an angel—I never heard a complaint from her in my life—not even when she was suffering tortures—but the doctors say now that another failure of her heart would be fatal. ”

“ Filmed with the cooperation of the College of Medical Evangelists' School of Medicine and the Los Angeles County Hospital.
Summary: Stresses that the length of our lives is determined by how we live today, and that many deaths caused by heart failure result from improper diet, physiological and psychological stress, and lack of proper medical care.
Credits: Produced and written by Herbert Morgan; director, Gunther J. Fritsch; music score, William B. Lava; film editor, Chester W. Schaeffer.
© Loew's Inc.; 29Mar49 (in notice: 1948) ; MP4007.
HEART TROUBLES. RKO Radio Pictures, Inc., c1949. ”

“ Friction phenomena are not perceived. There are as symptoms dizziness and faintness, drowsiness, difficulty of breathing, sense of præcordial oppression, weak pulse, and, when myocarditis exists, pain in the heart. The prognosis generally is unfavorable. Death, if not the direct result of the causes producing hæmopericardium, is due to the hemorrhage or to failure of the heart.
The TREATMENT consists in absolute rest, in giving readily-digested food, and in supporting the action of the heart; for this purpose stimulants may be required, unless something in the history of the case forbid. ”

“ Cardio-vascular disorder and disease referable to nervous strain pure and simple is amenable to treatment by complete and prolonged rest or relaxation in the majority of instances. Still, death may occur from sudden cardiac failure; or should advice be neglected or soon forgotten, as happens so frequently in these subjects, the attendant high arterial tension and vascular degeneration too often end in cerebral lesions, with or without Bright's disease. ”

“ This load of the heart is also shown by an increased pulse rate and increased respiratory efforts. In cardiac failure, as the systolic pressure falls the diastolic is likely to be increased, and the pressure pulse thus diminishing, allows insufficient blood to go to the medullary centers, and death soon occurs. ”

“ What I wish to maintain is that in cardiac degeneration of any kind, in chronic cardiac dilatation, and in the enlarged heart of Bright's disease and of emphysema, just as in ordinary valvular disease, attacks of distress, alarming both to patient and doctor, often occur which call for nothing more in the way of treatment than attention to some intercurrent influence—an indigestible meal, loaded bowels, a nervous shock, a thoughtless effort, a passing hardship or nervous strain. Digitalis and its allies, strychnine, alcohol, nitrites, iodides and the rest are out of place in such an event. ”

“ Every day—every day—more than 600 Americans die from sudden cardiac arrest. In some cases, the cause is long-term coronary artery disease. In others, it can be triggered by intense emotional or physical stress. Either way, the heart starts beating chaotically and cannot send blood to the brain and other vital organs.
The key of survival is the speed of response. In addition to CPR, most cardiac arrest victims need an immediate electrical shock to restore the heart's normal rhythm. When victims receive that shock within a minute, there's a 90 percent chance of resuscitation. ”

“ But when we come to consider cardiac strain a little more closely, it may be just as easily maintained that every dilated heart, every dilated cardiac chamber, every dilated blood-vessel has been strained. Whether, on the one hand, valvular disease, Bright's disease or emphysema, or, on the other hand, myocardial degeneration, has disturbed that cardinal condition of a normal circulation that the driving power must always exceed the resistance ahead, over-distension and dilatation of the cavities, with excessive stretching of their walls, constitute or consist in mechanical strain. ”

“ While angina pectoris and edema of the lungs were not infrequent causes of death in men, it was a rare cause of death in women. Dyspnea is a frequent symptom, and one for which many patients seek medical advice.
A constant systolic blood pressure of over 200 shows a probability that the patient will ultimately die either of uremia or of apoplexy. Janeway found that those patients who are to die from cardiac weakness show cardiac symptoms early in their disease. ”

“ This form of valvular lesion is the one that is most likely to cause sudden death. In aortic regurgitation Nature causes the heart to beat rapidly. Such a heart must never beat slowly, as the longer the diastole prevails the more blood will regurgitate into the left ventricle, and death may occur from sudden anemia of the base of the brain. Such a heart may, of course, receive a sudden strain, or the left ventricle may dilate, and yet serious myocarditis or fatty degeneration may not have occurred. ”

“ His experience is not uncommon, and probably every physician who sees many cases of heart disease can recall a few of them. Ten years ago I saw a man past seventy suffering from distinctly irregular heart action, though he gave the history of having had cardiac irregularity for some years at least, and he is still alive, past eighty, and with his heart irregularity still present. I have a patient over seventy whom I know to have had irregular heart action for fifteen years, and he himself is sure that it has been present since he was about forty, at least. ”

“ During any cardiac anxiety in this kind of insufficiency the patient breathes better when he is sitting up or reclining with the head and shoulders high. The reason for this is probably because his heart has more space in this position—the same reason that he breathes better when his stomach is empty. Very indicative of the coming cardiac insufficiency is the inability to lie at night on the left side. The pressure of the body, especially if the person is stout, interferes with the heart action and causes dyspnea and distress. ”

“ This occurs frequently to those who have supposed themselves to be in perfect physical health. Some sudden strain which they have previously been able to endure without injury, such as carrying a weight upstairs, cranking a refractory engine, pumping up a series of tires, or walking rapidly with a younger or more active companion, will suddenly give cardiac distress signals, serious exhaustion and more or less lengthy prostration, perhaps for an hour or so, or perhaps for several days. Permanent cardiac weakness may follow, or compensation may again occur, to be more easily broken later. ”

“ Anything which seriously excites him, whether anger or a stimulating drug, is harmful. Any disease which he may acquire, especially lung disturbances, as pneumonia or even a serious cough, requires that he take better care of himself and be more carefully treated and take more rest in bed than a patient who has not a damaged heart. Anything which raises the blood pressure is of course more serious for his heart than for a perfect heart; therefore drinking large amounts of liquid, even water, is inadvisable. It simply means so much more work for the heart to do. ”

“ And unless you yourself can either cure that, or will make head against it, worry, my dear Lady Montfort, will end not in consumption—you are too finely formed to let worry eat holes in the lungs—no; but in a confirmed aneurism of the heart, and the first sudden shock might then be immediately fatal. The heart is a noble organ—bears a great deal—but still its endurance has limits. ”

“ Like many women, I assumed heart disease was a "man's disease." But the Heart Truth is this: that heart disease is the leading cause of death among American women. In 2002, the National Heart, Lung, and Blood Institute launched the Heart Truth campaign, and asked me to join.
Over the last five years, I've seen the Heart Truth campaign spread the word to women about how they can protect their heart health. Symptoms of a heart attack can be different in women than in men. Symptoms in women can include persistent fatigue, difficulty breathing, and a pain in the jaw or neck. ”