The heart participates but little in the malaria process. Apart from light grades of hypertrophy and degeneration of the myocardium with dilatation encountered in cachectics, there is no lesion positively determined to be due to malaria.
French writers (Duroziez, Lancereaux) have endeavored to show a connection between endocarditis and malaria , but the number of their observations is so small that they cannot be regarded as convincing.
The systolic murmurs not infrequently audible at the different orifices during the acute infection, and likewise later, together with the increase in heart dulness, are symptoms common to all feverish conditions accompanied by anemia. They are "accessory" symptoms. Rauzier and Fabre have occupied themselves with this question.
According to Fayrer, rheumatism is a frequent complication in
India, occurring most commonly in the natives, but also in foreigners, though endocarditis is not associated with it.
He observed in Europeans resident for a long time in Bengal a condition which he describes as asthenia cordis. This consists in an uncomfortable sensation in the region of the heart, that at times may become so irritating as to wake the patient from sleep during the night. It sometimes recalls angina pectoris. The heart dulness is increased, the pulse arhythmic, the respiration dyspneic.
Aortitis, with subsequent neuritis of the cardiac plexus and angina pectoris, has been described as an effect of malaria by Lancereaux. The stenocardiac paroxysms are manifested by sharp pain in the chest, radiating to the arms, a flow of saliva, and diuresis. The inflammation is localized, at the beginning, to the aorta, and in contrast to ordinary arteriosclerosis, commences in the tunica externa, from where it passes over to the cardiac plexus, producing the paroxysms of pain.
When we consider that Lancereaux saw only two cases, both of which showed a narrowing of the coronary arteries, and in both of which the malaria preceded the aortic affection by many years, his conclusions give ground for skepticism, both in relation to the etio logic role of the malaria and the connection of the neuritis of the cardiac plexus with the stenocardia. Le Roy de Mericourt and Laveran both affirm that they have not observed a greater number of cases of angina pectoris in Algeria than in France; consequently they deny any connection between this affection and malaria.
We have already mentioned, in the discussion of cachexia, that phlebitis of different veins with subsequent thrombosis has been frequently seen in cachectics with advanced anemia. It occurs usually in veins of the lower extremities; less often in those of the arms and the neck. Pyelothrombosis has likewise been observed, even though rarely; also cardiac thrombi.