FATTY INFILTRATION. 321 



are often so greatly increased as to justify the term " cor bovi- 

 nuni". As long as the hypertrophy is compensatory there are 

 no symptoms ; but when the cardiac muscle can no longer 

 meet the demands made upon it, the results are most serious. 

 If the left ventricle is at fault, there is a passive congestion 

 of the pulmonary circulation. When the right ventricle is 

 at fault, or in turn becomes involved, there occur passive con- 

 gestion of the general systemic circulation and dropsy. 



DEGENERATIVE CHANGES. 



Cloudy Swelling. 



Cloudy swelling occurs either as an early stage of inflamma- 

 tion or as a precursor of fatty degeneration. It is noted 

 especially in the course of diphtheria, smallpox, scarlet fever, 

 and other infectious diseases; also in rheumatism and after 

 severe burns. 



The myocardium is soft even friable, pale, and looks as 

 if it had been slightly boiled. 



Microscopically the muscle-fibres are seen to be swollen the 

 spaces between the individual muscle-fibres being smaller than 

 normal and their transverse striations are indistinct. The 

 fibres appear as though seen through ground glass or a layer 

 of dust, due to the presence of innumerable fine albuminous 

 granules. 



Fatty Infiltration. 



Normally there is a certain amount of adipose tissue beneath 

 the epicardium, especially along the course of the coronary 

 arteries, lower border of the left ventricle, and at the apex. 



Pathologically the adipose tissue may not only form a thick 

 coating over the entire surface, but even extend into the walls 

 of the heart between the muscle-fibres, deposits even appear- 

 ing at places under the endocardium. The muscle-fibres 

 themselves are not involved, except that they are often 

 atrophied as the result of pressure, when the accumulation of 

 adipose tissue is excessive. Besides the cardiac weakness thus 

 resulting, a fatty degeneration of the muscle-fibres may be 

 induced. 



21 Hist. 



