Primary Myocardial Disease

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Abstract
The clinical and hemodynamic findings in 50 cases of primary myocardial disease (cardiomegaly and failure in the absence of any known etiology) have been analyzed and the pertinent literature has been reviewed. Etiologically, chronic alcoholism and malnutrition have appeared as the most important etiologic agents. The clinical picture has been one of significant cardiomegaly with recurrent episodes of failure, dysfunction of both ventricles manifested by simultaneous failure of both left and right hearts, loud biatrial and biventricular gallops and murmurs of functional mitral and tricuspid regurgitation. Indirect evidences of early right ventricular involvement such as exaggerated jugular "A" waves and palpable liver "A" waves separated this condition from other common heart diseases marked by a predominant left ventricular involvement. The chest roentgenograms have been characterized by diffuse enlargement of the heart with dilatation of all chambers and the electrocardiograms have displayed nonspecific QRS and T changes. High diastolic blood pressure during failure has been a frequent finding and many cases of this disease have been labeled as hypertensive cardiovascular disease. Response to bed and digitalis has been as a rule gratifying until the late stages of the disease. Pathologically, the disease has been characterized by nondescript fibrosis and myocardial fiber hypertrophy.