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
5. Cardiac Emergency Drugs.--Besides some of the drugs already
mentioned (such as camphor hypodermically, nitroglycerin when
indicated, strophanthin hypodermically or intravenously, caffein and
strychnin), often ergot, suprarenal vasopressor principle, pituitary
vasopressor principle, atropin and morphin should be considered.
When there is low blood pressure, venous stasis, pulmonary
congestion, cyanosis and a laboring, failing heart, intramuscular
injections of ergot, with or without coincident venesection, may be
the most valuable method of combating the condition. Life has been
saved in this kind of sudden acute cardiac failure in valvular
disease. When venesection is not indicated in certain conditions of
low blood pressure and heart failure, ergot has saved life. It
causes contraction of the blood vessels and seems to tone the heart.
Incidentally it quiets the central nervous system. If the blood
pressure is much increased by it, the ergot should not be repeated,
as too much work should not be thrown on the heart muscle. Often,
however, it may be administered intramuscularly with advantage in
aseptic preparation as offered in ampules, at the rate of one ampule
every three hours for two or three times, and then once in six hours
for a few times, the future frequency depending on the indications.
Epinephrin and Pituitary Extract: The blood pressure-raising
substance of the suprarenals or of the pituitary gland (hypophysis
cerebri) has been much used in heart failure. These substances
certainly would not be indicated in high blood pressure; they are
indicated in low blood pressure. They have been given intravenously;
they are frequently given hypodermically. They often act rapidly
when a solution in proper dose is dropped on the tongue. The blood
pressure rise from epinephrin is quickly over; that from the
pituitary extract lasts longer. In large doses, or when it is too
frequently repeated, epinephrin depresses the respiration. Pituitary
extract acts as a diuretic. Sterilized solutions of both, put up in
ampules ready for hypodermic medication, are obtainable, the
strength offered generally being 1 part of the active principle to
10,000 of the solution. Hypodermic tablets of epinephrin may also be
obtained. Stronger solutions of 1 part to 1,000 may be dropped on
the tongue, or tablets may be dissolved on the tongue. The blood
pressure is temporarily raised and the heart stimulated by these
treatments, but epinephrin is not used so often for cardiac failure
as it was a short time ago.
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