Iodides frequently upset the stomach. Be cautious in the use of them. The irritable stomach may turn the scales against your patient.
Use cardiac stimulants with care and judgment. If all the valuable ammunition is used up at first, the fight will be lost.
Use digitalis with especial care. Its chief usefulness is in steadying the decompensated heart, improving the conduction of impulses, and increasing the tone of the cardiac muscle. It should never be given to patients with very slow pulses, the subjects of Stokes-Adams syndrome. Digitalis has been found to produce partial to complete heart block when therapeutically administered.
Remember that in the uncompensated heart morphine not only eases the oppressive dyspnea, but also steadies and stimulates the heart.
See to it that the patient has a daily movement of the bowels. In the early stage try the effect of liquid paraffin or of the mineral waters such as Pluto, or Hunyadi Janos, or artificial Carlsbad salts (Sprudel salts). These last can be made as follows: Sodium chloride, ℥I; sodium bicarbonate, ℥II; sodium sulphate, ℥IV. Take two tablespoonsful of this in a glass of hot water before breakfast. Should these not succeed, assist the action of the drugs by the use of enemata. The pill of aloin, strychnine sulphate, and extract of cascara, with the addition of a small quantity of hyoscyamus, is a mild tonic purgative. In cases of constipation with high tension, there is no drug as valuable as calomel or one of the other mercurials given occasionally.
Never give Epsom salts unless copious watery stools are desired to deplete effusion into the serous cavities or into the subcutaneous tissue.
Chronic constipation increases the gravity of the prognosis.
In case of suppression of urine and anasarca, hot air packs may be of value. The patient may be wrapped in a hot wet sheet and covered with blankets. I do not believe in administering pilocarpine to assist the sweating.
Remember to treat the patient and not the disease. The careful hygienic and dietetic treatment, combined with the least amount of drugging, is the best and most rational method of treatment.