Trouble with the human body may be approached from the point of view of its structure or its function. The heart may be enlarged, or its valves may leak or be narrowed, or its blood supply may be inadequate because of blocking. The changes in structure produce changes in function which are reflected in symptoms. From the functional point of view the heart may beat too fast or too slowly, or irregularly. Its beat may be weak or strong. The heart may be overactive or underactive.

When the heart is overactive people complain of palpitation. The heart sounds are loud and the pulse is full and bounding. Signs of an overactive heart may be seen when one has had severe exercise or emotional stress. With excessive action of the thyroid gland the heart beats more rapidly, as it does also with severe anemia. Whenever there is fever or lack of oxygen the heart becomes overly active.

When the circulation of blood through the blood vessels is insufficient because of failure of the heart, which means under activity, the symptoms include apathy and lassitude, sometimes faintness, and collapse. If a sudden hemorrhage occurs the circulation fails. With failure of the heart the blood pressure falls and the skin becomes cold, clammy, dry, and inelastic.

In heart failure congestion of the lungs follows, with shortness of breath and the difficulty with breathing that occurs because of fluid.

The Overactive Heart

After severe muscular exercise the amount of blood returned by the veins to the heart increases. Something similar occurs when there is anemia, lack of oxygen, over activity of the thyroid gland or fever, Increase in materials carried in the blood occurs also in the toxemia of pregnancy, in dropsy, or with disturbances in the way in which the body uses salt and water.

As the inflow increases, the pressure in the blood vessels into which blood is pumped lessens. The heart beats more rapidly and strongly. As long as the heart can handle the change in its load of work, the patient may not be too much disturbed. When the load gets too big and the reserve power of the heart is damaged, emptying of the heal will fail to keep up with the inflow of blood. This may cause beginning failure of the heart.

If the flow of blood into the heart is inadequate, the tissues of the body will not get the blood and oxygen that they need. If this occurs suddenly, as it may do from a variety of causes, the brain does not get the blood and oxygen that it needs and the person faints or collapses.

Heart Failure

More people die from heart failure than from any other cause, and most likely conditions affecting the heart will continue from now on to be the leading cause of death.

Failure of the heart is usually associated with high blood pressure, and with extreme narrowing of the valves that carry the blood from the heart into the large blood vessel called the aorta into which the heart empties. The heart always makes an effort to handle its increasing burden. It does this by enlarging the muscle fibers and dilating to increase the size of its cavities. When the load gets too heavy the rhythm of the heart becomes irregular. There may be pain like that of angina pectoris. The cough that occurs is due to the congestion in the lungs. With heart failure digestive symptoms may be prominent, including nausea, vomiting and loss of appetite, and sensations of fullness in the middle of the abdomen. Of course, a heart that has been damaged by disease such as rheumatic fever or other infections is more likely to fail than a healthy heart.

Care Of The Failing Heart

The doctor's treatment of a failing heart is designed to take work off the heart, help to get rid of excess fluid, and improve the heart's action. The person with congestive failure of the heart is like a man who is going bankrupt because his income and assets have been sharply reduced. He has to cut down immediately on expenditures, and maintain a rigid conservation of what he has. In this condition the patient must depend on the doctor to outline his conduct for him. If the man must earn his living, he must get home after work as soon as possible and spend every moment he can actually resting; this applies equally to the use of the week-end. The person with a weak heart must avoid climbing stairs; must never lift heavy objects or carry packages. Every source of tension, including family disagreements and arguments, must be eliminated. Excess of tea, coffee, tobacco, and alcohol is a serious misdemeanor for the patient with congestive heart failure.

While rest must be the objective, enough movement must be employed to keep muscles alive. The simplest kind of household activity or, for some, a few holes of golf on a flat course may be desirable. Avoidance of boredom is also necessary, and for this purpose congenial conversation, selected reading, and simple card games, chess or checkers, may be helpful.

Blood Pressure

Your blood pressure is a measure of the activity of your heart in pumping, and of the resistance created by the size and the hardness of the walls of the blood vessels. When the doctor measures your blood pressure he puts an inflatable cuff around your arm, then stops the blood flow by pumping air into the cuff; then he listens with a stethoscope to get the pressure at the time when the heart was contracted - systolic pressure-and when it has dilated or relaxed-diastolic pressure. The pressure is taken by a column of mercury measured in millimeters or by a spring device calibrated to the mercury column.

Normal blood pressure may range from 95 to 160 systolic and 65 to 90 diastolic. There may be a range in the systolic pressure from 85 to 300 and in the diastolic pressure from 40 to 160. The pressure may vary with sleeping or waking, sitting or standing, with exercise, lack of oxygen or anemia; with chilling, anger, anxiety, frustration or the height of pleasure.

Low Blood Pressure-Hypotension

People with blood pressure below the average used to be said to suffer from low blood pressure. The condition was called hypotension. Hypotension is a condition in which the systolic pressure is under 80 mm. of mercury or 20 rom. below the usual average of the person concerned. The blood pressure may be low after prolonged rest in bed or with malnutrition. The blood pressure may also be lowered by conditions affecting the spinal cord or by the operation which cuts off the sympathetic nervous system. A feeling of faintness or weakness is indication that the blood pressure is lower than it should be.

High Blood Pressure-Hypertension

High blood pressure, or hypertension, is diagnosed by the doctor when, after repeated examination, the pressure is above the average in which the person lives. In the United States, levels are around 120 to 140 systolic and 80 to 90 diastolic. The pressure may reach 180 systolic and 100 diastolic without the appearance of any symptoms.

If the person suffers with acute hypertension, such symptoms as convulsions, loss of vision, severe headaches and kidney inflammations may be indications. In chronic high blood pressure dizziness, headaches, hemorrhages in the eye or the brain, heart failure and uremia may be present. Still, cases are known in which people with definitely high blood pressures on measurement have failed to manifest any of these symptoms.

The first indication of the condition is the changes in the blood vessels at the back of the eye, which the doctor sees with an ophthalmoscope. Definite relationships have been established between the blood-flow through the kidneys and the pressure of high blood pressure. A high salt or sodium chloride intake may set up high blood pressure. The pressure with high salt intake is associated with the functioning of the adrenal glands.

In an examination of the patient with high blood pressure study of the urine, which indicates the condition of the kidneys, is important. A low specific gravity-under 102D-and the presence of albumin or pus may show that the kidney condition is responsible. If the kidney function, as determined by a variety of tests, is normal, the doctor then sees if the adrenal activity is proper. A number of laboratory and functional tests are available which the doctor can use.

The suggestion has been made that the first steps are: reassurance of the patient, sedation with the appropriate drugs and restricted use of salt. Rigid elimination of salt from the diet is recommended when there is headache, dizziness, and heart failure. Several drugs are known which will lower blood pressure but all are difficult to use and may have unfavorable effects. Reduction of weight, rest, mental hygiene, are the best measures that can be recommended in a majority of cases of high blood pressure.