Show BY WILLIAM I MECHANICAL TESTS OF THE HEART No examination of a patient with heart disease is complete without a chemical and analysis to determine the state of the kidney function for excretion from the kidneys kidneys kidneys kid kid- depends largely upon the effIciency efficiency efficiency effi effI- of the heart Any individual who can hold his breath for thirty-five thirty seconds or 01 more by the watch has a competent heart no matter whether the valves leak or the muscle is damaged In surgical practice if the kidneys are not seriously impaired and if the patient patient patient pa pa- tient can hold his breath twenty-five twenty seconds or more an operation is deemed s safe fe Inability to hold the breath however does not signify heart disease it Is more definitely a sign of acidosis the accumulation of a carbonic acid gas in the tissues and blood carbon dioxide and of other acids being particularly noticeable in diabetes uremia and other severe forms of autointoxication The Tho normal normal normal nor nor- mal breaking point the point at which one is forced to take another breath is forty seconds for an adult Some individuals in excellent general condition can hold the breath forty- forty five or even fifty seconds ls without preparation Of course by preliminary preliminary preliminary prelim prelim- inary deep breathing for two or more minutes without hurry or overexertion overexertion overexertion tion any normal Individual should be beable beable beable able to hold his breath 90 seconds or two minutes Mechanical tests dis disclose lose the reserve re- re re reserve reserve re- re I serve power of the tho heart Obviously the patient will not respond to the test normally if the reserve power of ot the heart is being drawn upon by any handicap such as high blood pressure pronounced autointoxication hardened arteries or acute illness In a normal Individual the pulse rate increases from four to eight beats per minute when the standing posture is assumed That is is the pulse is four to eight beats faster than it is when the individual is ly lyIng lying ly- ly ing down If the heart is diseased the pulse rate is ten to twenty beats faster when the standing posture is assumed If the pulse rate is say 65 per mInute minute minute min mIn- ute in the horizontal posture and 72 per minute in the standing posture it should be from 85 to 95 per minute Immediately after twenty deep flex flex- ions of the legs at the rate of one per second It should return to the tho normal rate within three minute af after after af af- ter the If It the heart is incompetent in- in competent that is iR is If the reserve power is reduced by disease the in increasE increase in- in crease of pulse rate is greater after this exercise and it is from five to ten minutes returning to normal rate with rest It is but fair to state that mere nervous irritability will produce exaggerated response to all of these mechanical tests but if it nervousness is tho sole underlying condition there is always a prompt return to normal with rest Of course nervousness and organic disease often ofton go to to- to gether |