ATROPHY OF THE HEART. 



plies still more forcibly to the excentric atrophy. The latter almost 

 completely coincides with simple dilatation. Indeed, it would be almost 

 impossible to decide whether the walls have been thinned by excessive 

 distention alone (dilatation), or whether atrophy of their elements 

 have contributed to their attenuation (excentric atrophy). True, the 

 effect of the two conditions is not quite the same, for, if the walls of a 

 dilated heart be also thinned (as they sometimes are by accumulation 

 of fat about the heart, and as is observed most typically in the indu- 

 rated thickening of the epicardium which remains after a chronic peri- 

 carditis), we find the propulsive power of the organ to be much more 

 reduced than is the case in simple dilatation. We have, finally, to 

 mention that, when the contents of the left ventricle have been reduced 

 as a result of contraction of the left auriculo-ventricular orifice, a most 

 classical diminution in size and atrophy of the left ventricle is often 

 observed. 



SYMPTOMS AND COURSE. According to Laennec, congenital atro- 

 phy of the heart is the cause of frequent attacks of fainting. Accord- 

 ing to Hope, besides the tendency to faintness, the signs of defective 

 nutrition of the body, great muscular debility, palpitation of the heart, 

 signs of anaemia, and chlorosis, are to be found in persons suffering 

 from congenital smallness of the heart. 



Acquired cardiac atrophy varies in its symptoms, according as it 

 forms a part of a general state of marasmus, or stands alone, indepen- 

 dent of poverty of blood or wasting of the general system. In the 

 first instance, the symptoms are not very prominent. In fact, in certain 

 cases, it can hardly be decided whether the enfeebled propulsive power 

 of the heart depend upon lack of energy in its contraction, or upon 

 atrophy of its muscles. In either case, the arteries are incompletely 

 filled, and the blood accumulates in the veins. As, however, the blood 

 itself is reduced in quantity, there are no signs of extreme venous en- 

 gorgement. Severe dropsy, or well-marked cyanosis, is hardly ever 

 met with in this form of atrophy of the heart. The bluish hue of the 

 lips, the varicosities upon the cheeks of old men, the small effusions 

 into the subcutaneous tissue in the hands and feet, which are usually 

 cool and slightly bluish, are only partially dependent upon feeble pro- 

 pulsive power. Atrophy of the lungs, as we have already seen, con- 

 tributes largely to the establishment of these symptoms. 



Atrophy of the heart, arising in consequence of local derangements 

 of nutrition, long-continued compression of the heart, or stricture of 

 the coronary arteries, has a very different character. In the first place, 

 the patient often complains of a distressing palpitation, a symptom 

 which, as stated in a previous chapter, generally exists when the heart 

 is unable to keep up the circulation without very great exertioa 



