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
If the nitrites, no preparation seems to act more satisfactorily
than nitroglycerin (trinitrin, glyceryl nitratis, glonoin). Its
action may not be so prolonged as other forms of nitrite, such as
sodium nitrite or erythrol tetranitrate, but it is not irritant, and
only a little less rapid than amyl nitrite, and although the marked
dilation lasts but a short time, often apparently only for minutes,
still, when frequently repeated or given a few times (from four to
six) in twenty-four hours, it frequently keeps the blood pressure
lower than it would be without the drug. In diseases of the heart
the sudden vasodilation caused by amyl nitrite inhalations is
indicated only in angina pectoris. "Then the surface of the body
tends to be cold, however, when the peripheral blood pressure is
increased and the heart is laboring, nitroglycerin in small doses is
valuable. The dose may be from 1/400 to 1/100 grain, dissolved on
the tongue or given hypodermically for quick action, or given by the
mouth for more prolonged action. In sudden cardiac dyspnea
nitroglycerin sometimes acts specifically, especially when there is
asthma. When a drop or two of the official spirits, which is a 1
percent solution, is given on the tongue, or a soluble tablet of
1/100 grain is dissolved on the tongue, the action is almost as
rapid as though the dose had been administered hypodermically. Many
times when such increased peripheral circulation is desired and
alcohol seems indicated, nitroglycerin in small doses will act as
well. It cannot be termed a cardiac stimulant, although many times a
heart acts better and the pulse is fuller and stronger after
nitroglycerin than before. It should not be used, except if
specially indicated, in broken compensation or in other myocardial
weakness.
Iodids: These have no immediate action. The vasorelaxation that
often occurs from iodid is quite likely due to the stimulation of
the thyroid gland by the iodin, and the thyroid gland secretes a
vasodilating substance. Small doses of iodid, however, when
indicated in various kinds of sclerosis, have seemed to lower blood
pressure. While large doses may have more of this actioli, they are
not now under consideration, and large doses are rarely indicated.
Too mach iodid has been given for many conditions. If the
indications for an iodid are present, such as sclerosis anywhere, or
unabsorbed inflammatory products, exudation in or around the heart,
or an apparent insufficiency of the thyroid, from 0.1 to 0.2 gm. (1
1/2 to 3 grains) once or twice in twenty-four hours, after meals, is
all that is required to give the action desired, and the circulation
is benefited. It is sometimes a question whether small doses of
iodid are not actually stimulant to the heart, possibly through the
action on the thyroid gland.
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