The recent discussion by Dr. Henry A. Christian6 of chronic nonvalvular disease of the heart presents a clinical condition that is becoming more and more frequent in this age of restlessness and strenuosity. Our play is frequently more strenuous than our daily labors; the result is heart tire.
As pointed out by Christian, heart murmurs may be absent with myocardial tiredness, or there may be a soft systolic blow at the apex. The heart may not be evidently enlarged, although there is almost always some hypertrophy, especially of the left ventricle, as shown by careful percussion, roentgenograms and fluoroscopy. Most hearts reaching the stage of association with symptoms of tire have suffered years of overwork, which has caused hypertrophy and chronic myocarditis. Serious acute infection or long continued chronic infection may be the primary cause of the myocarditis that later leads to cardiac tire.
As suggested by Christian, there