The treatment of true Stokes-Adams disease is unsuccessful. If general arteriosclerosis is present, that condition should be treated. Digitalis would seem almost invariably contraindicated, although it is of value in extrasystoles without heartblock, or in conditions which are not Stokes-Adams disease; but if this disease was considered present, digitalis would probably do harm. Sometimes strychnin is of benefit.
Atropin has sometimes caused stimulation of the heart to more normal rapidity. Its benefit is generally only temporary, as most patients cannot take atropin regularly without having it cause a disagreeable drying of the throat and skin, a stimulation of the brain, and an undesired raising of the blood pressure, to say nothing of its action on the eyes.
The only value of the nitrites is when the blood pressure is high and the nitrite action is desired on that account.
Coffee or caffein often causes these hearts to become irritable; it certainly raises the blood pressure, and therefore is not generally advisable. Both tea and coffee should generally be prohibited.
During the acute faint attack, camphor is one of the best stimulants. Alcohol may be of benefit. If syphilis is a cause of the condition, iodids are always valuable. If syphilis is not a cause and arteriosclerosis is present, small doses of iodid given for a long period are beneficial, although it may not much reduce the blood pressure or decrease the plasticity of the blood. Iodid is a stimulant to the thyroid gland, and therefore it is on this account valuable.
An excellent stimulant to the heart is thyroid secretion or thyroid extract. Theoretically thyroid extracts should be the treatment for a slow-acting heart. It sometimes seems of benefit to these patients, but it often causes such nervous excitation and irritability as to preclude its use. The dose of thyroid for this purpose would be small, about one-fourth to one-half grain of the active substance three times a day. To be of any value, the preparation must be good.
Epinephrin has been shown by Hirtz [Footnote: Hirtz: Arch d. mal. du coeur, February, 1916] to overcome experimental heart block. It is not clear just how it acts, but it could well be tried in heart block when the blood pressure is not too high. A few drops of an epinephrin solution 1:1,000 may be placed on the tongue, and repeated three times a day, or from 5 to 10 minims of a weaker solution may be given hypodermically.
The usual precautions against overeating, overdrinking, severe physical exercise, sudden movements, overuse of tobacco, etc., should all be urged on the patient. The disease is sooner or later fatal, although the patient may live some years. Death is generally sudden.
It is understood that this disease must he separated from the condition of bradycardia inherent in a few persons who have a slow pulse throughout their life, without any untoward symptoms.