Disturbances of the Heart: Discussion of the Treatment of the Heart in Its Various Disorders, With a Chapter on Blood PressureOsborne, Oliver T. (Oliver Thomas)
Science
Disturbances of the Heart: Discussion of the Treatment of the Heart in Its Various Disorders, With a Chapter on Blood Pressure
Osborne, Oliver T. (Oliver Thomas)
Blood pressure; Heart -- Diseases
It is essential, then, that these patients should not hasten and
should not become excited; and any drug or stimulant which would
cause cardiac excitement is bad for them. On the other hand, these
are the very patients in whom, sometimes, alcohol in small doses may
be advisable, especially if the patient is old; and a dose of
alcohol used medicinally when an attack of cardiac disturbance is
present is good treatment. The quick dilatation is valuable.
Nitroglycerin will also do good work in these cases, and with high
blood tension may be the only safe drug for the patient to have on
hand. As soon as his attack occurs, with or without real angina
pectoris, let him dissolve in his mouth a nitroglycerin tablet. If
he feels faint, he will feel better the moment he lies down, and in
this instance he may be improved by a cup of coffee, or a dose of
caffein or camphor.
If the left ventricle becomes still weaker and shows signs of
serious weakness, or if there is actual dilatation, the question of
whether or not digitalis should be used is a subject for careful
decision. The left ventricle should not be forced to act too
sturdily against this aortic resistance. Consequently the dose of
digitalis must be small. On the other hand, it frequently happens,
especially in old age, that myocarditis or fatty degeneration has
already occurred before this cardiac weakness develops in the
presence of aortic narrowing, and digitalis may not be indicated at
all. We cannot tell how far degeneration may have gone, however, and
small doses of digitalis used tentatively and carefully, perhaps 5
drops of an active tincture two or three times a day, and then the
drug carefully increased to a little larger dose to see whether
improvement takes place, is the only way to ascertain whether or not
digitalis can be used with advantage. If it increases the cardiac
pain and distress, it should not be used. Strychnin is then the drug
relied on, with such other general medication as is needed, combined
with the coincident administration of nitroglycerin, which may also
be given in conjunction with digitalis, if deemed advisable.
Generally, however, if a heart with aortic stenosis needs
stimulation, the blood pressure is generally none too high, although
there may be arteriosclerosis present. Therefore when nitroglycerin
is indicated to lower blood pressure, digitalis is not usually
indicated; when digitalis is indicated to aid the heart,
nitroglycerin is generally not indicated. These patients must have
high blood pressure to sustain perfect circulation at the base of
the brain.
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