FATTY DEGENERATION OF THE HEART. 377 



doubt as to whether the retarded circulation and the scanty arterial 

 supply be due to general exhaustion or to relaxation of the heart. 



Growth of fat about the heart plays an important role among the 

 people, in accounting for shortness of breath and other troubles arising 

 among fat, pot-bellied individuals. Unless the accumulation cause 

 atrophy of the muscular substance, which is by no means frequent, it 

 it does not seem to occasion any functional disturbance whatever. 

 Should atrophy result, the symptoms already mentioned (see atrophy 

 of heart) will arise. 



Fatty degeneration of the cardiac substance, like simple relaxation 

 of it, depresses the action of the organ, and in like manner, when it 

 affects the whole heart, occasions dilatation. All the circulatory dis- 

 turbance which we have so repeatedly described may ensue from fatty 

 degeneration. We find a feeble heart-shock, a small and remarkably 

 slow pulse, a tendency to faintness, from an imperfect supply of blood 

 to the brain. If the volume of the blood be not diminished, that is, if 

 the degeneration depend upon local rather than upon general nutritive 

 disorder, there may also be cyanosis and intense dropsy. In the latter 

 case, when the disease is usually combined with other affections capable 

 of reducing the propulsive power of the heart (such as pericardial ex- 

 udations, induration and thickening of the pericardium, etc.), it is 

 difficult to determine what part is taken by these disorders, and what 

 the degeneration plays in producing the train of symptoms ; so that a 

 positive diagnosis is impossible in most instances. The same thing 

 holds good with regard to the transition from genuine to spurious hy- 

 pertrophy, through fatty degeneration of the muscular fibres. If the 

 impulse and contractile force of a hypertrophied heart become mani- 

 festly weaker, or if compensation for an imperfect valve begin to fail, 

 we may assume that the change from true to false hypertrophy has 

 taken place. Fatty metamorphosis of the papillary muscles is also to 

 be reckoned among the possible consequences of insufficience of the 

 mitral or tricuspid. 



Of rupture of the heart, as a result of fatty degeneration, we shall 

 treat hereafter. 



As for amyloid degeneration of the substance of the heart, evi 

 dence, often easy to obtain, of existence of the disease in the liver 

 spleen, or kidney, affords our only but uncertain clew as to its presence 

 in the. heart ; and we can never do more than vaguely suspect it. 



Cancer, tubercles, and parasites of the heart, also have the effect of * 

 depressing its action, but their diagnosis is almost always impossible. 



TREATMENT. If the heart be relaxed by debility following acute 

 disease, the remedies so often named are called for which have the 

 effect of improving nutrition, together with mild stimulants. 



