Rupture of the Heart.

This very rare accident occurs after the heart has been weakened by degenerations, especially fatty degeneration. Quain has found this to be the cause in seventy-seven out of a hundred cases examined.

Suppurative myocarditis and obstruction of the coronary artery resulting in anemic necrosis, are also responsible. It occurs most frequently after the age of sixty, the time of life when the degenerative changes culminate so disastrously. It occurs more frequently among males than among females, owing to the more strenuous life of males. The culmination may be the result of severe exertion, though it has occurred when the patient was at perfect rest.

The point of rupture is usually in the anterior wall of the left ventricle, more rarely in the right ventricle. The pericardium is generally filled with dark, coagulated blood.

Symptoms.—This accident usually results in sudden death The patient is seized with a sharp, stablike pain, may cry out in his anguish, and fall unconscious, or, grasping the region of his heart with his hand, remain stationary, fearing to move. A deathlike pallor spreads over the face, the surface is covered with a cold sweat, the pulse is tumultuous, and the patient falls unconscious. If he survives a few hours, the dyspnea is marked and the pain agonizing in character. Mays reports a case that lived for seventeen days after the rupture.

Diagnosis.—Excruciating pain in the cardiac region, pallor of face, cold sweat, and a sense of suffocation, would suggest a rupture of the heart.

Prognosis.—The prognosis is always hopeless, for if death is not sudden, the patient's life is prolonged but for a few hours or a few days at most.

Treatment.—The only treatment that will be of great benefit will be prophylactic, for after the accident, opiates, to relieve the intense pain, is all that can be used.

In every case where there is reason to believe that myocarditis, obstruction of the coronary arteries, or degenerations exist, the physician should explain the danger and the result which is liable to follow, unless the patient leads a very temperate life.

All excesses should be avoided. The diet should be nutritious, but easily digested, and as little fluid as is consistent with health should be allowed. Gentle exercise in the open air, and a residence in an equable climate is desirable; unfortunately but few can profit by such advice, though very much depends upon one's environment.

When rupture has occurred, complete rest in bed, hypodermic injections of morphine, with local applications to relieve pain, will constitute the treatment. Stimulants should be avoided, as they increase the hemorrhage.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.