The Pathological Heart Conditions in Hookworm Disease and Their Causes

The clinical picture of the heart affection in a severe hookworm infection resembles certain valvular diseases in so many features that one has to describe it in some detail to recognize the characteristic points necessary for the differential diagnosis. Palpation of the heart region reveals displacement of the apex beat outwards and downwards, usually in the sixth inter-costal space outside the mid-clavicular line, and sometimes situated in the anterior-axillary line; the apex beat is slapPing, snapping, quickly disappearing, unless the heart muscle is badly damaged, subsequent to which condition it becomes diffuse, indistinct or mpalpable. The heart rate is increased to about 110. Sometimes a systolic thrill is palpable in the apical region and occasionally the second Pulmonary sound is to be felt in the second left interspace at the left heart border. Epigastric Pulsation is frequently present. Purcussion shows that the heart is enlarged to the left, and also downwards and to the right, resembling the configuration of an enlarged mitral heart (' third stage '). On auscultation, one finds in the apical area a loud, thumping first sound, corresponding to the slapping apex beat; it becomes fainter with a progressive myocardial weakness. In the same area a systolic murmur is audible, sometimes harsh, sometimes softer, and not rarely conducted towards the axillary region; if it is harsh and low-pitched, a systolic thrill is Palpable. The pulmonary second sound is frequently accentuated and a systolic murmur, louder and harsher than that in the apical area, js audible. Both the murmurs are diminuendo in character. Whether a thrill is palpable in the pulmonary area depends again on the number of vibrations produced by the murmur; the lower pitched it is, the more probable is the appearance of a thrill. X-ray examination reveals a dilatation of the left ventricle, the pulmonary cone and the right auricle; the ' heart waist' or incisure is usually straightened, so that the picture of an enlarged mitral heart results, but the pulsation of the heart silhouette is quite different from that seen ln mitral disease; it is considerably increased and resembles the expansile pulsation in aortic regurgitation. The electrocardiogram of untreated severe hookworm ansemias is very typical. The general ' voltage' is low; the P-Q interval usually normal; the Q RS complex occasionally more than 0.1 sec. but not severely damaged; the S-T junction sometimes slightly depressed