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The recognition of an incompetent heart is usually not difficult. The dyspnea of exertion, the sense of post-sternal weight and constriction of the chest, the cough of exertion, and upon assuming the recumbent position, the enlarged liver with tenderness and often with pain or a feeling of weight in the epigastrium, the indigestion of portal congestion, the usually scant urine, the edema of the feet, or all of the above named conditions much aggravated until constant dyspnea with orthopnea, general anasarca, excessive physical weakness, marked palor, or palor and cyanosis give unmistakable evidence of cardiac weakness. The local signs of valvular disease may be absent or present. Signs of cardiac enlargement with dilatation of the chambers of the heart are present and may usually be recognized.
These phenomena are usually present in varying degrees of severity, in an incompetent heart. When due to intrinsic heart disease a valvular lesion or
BILLINGS F. THE DIFFERENTIATION OF THE CARDIAC INCOMPETENCY OF INTRINSIC HEART DISEASE AND OF CHRONIC NEPHRITIS. JAMA. 1898;XXXI(3):99–103. doi:10.1001/jama.1898.92450030001001
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