Disturbances of the Heart / Discussion of the Treatment of the Heart in Its Various Disorders, With a Chapter on Blood Pressure

by Oliver T. Osborne

Deficiency in the thyroid secretion will always cause a heart to be slower than normal. The more marked and serious the hypothyroidism, the slower the heart is apt to be. When such a condition is diagnosed, the treatment is thyroid extract; or if the insufficiency is not great, small doses of an iodid should be given. In either case it is sometimes astonishing how rapidly a slow, sluggishly acting heart, improves and how much improvement there is in the mental condition of the patient.

In acute slowing of the heart, as in syncope, the patient must immediately lie down with the head low, possibly with the feet and legs elevated, and all constricting clothing of the abdomen and chest should be removed. Whiffs of smelling-salts may be given; whisky, brandy or other quickly acting stimulant, not much diluted, play also be given. Camphor, a hypodermic dose of strychnin or atropin if deemed necessary, a hot-water bag over the heart, and massaging of the arms and legs to aid the return circulation, are all means which are generally successful in restoring the patient's circulation to normal. Caffein is another valuable stimulant, perhaps best administered as a cup of coffee. Digitalis is not indicated: neither is nitroglycerin, unless the slow heart is due to cardiac pain or to angina.

Some patients have syncopal attacks with the least injury or with any mental shock. Such patients as soon as restored are as well as ever. Other patients who faint or have attacks of syncope should remain at rest on a couch or bed for some hours.

A tangible cause, being discovered for an unusually slow heart is sufficiently indicative of the treatment not to require further comment. While generally toxins from intestinal indigestion make a heart irritable and more rapid, sometimes they slow a heart, and in such cases the heart will be improved when catharsis has been caused and a modification of the diet is ordered.

PAROXYSMAL TACHYCARDIA

This condition is generally termed by the patient a "palpitation," and palpitation of the heart is recognized by most physicians as meaning a too rapidly acting heart, the term "tachycardia" being reserved for an excessive rapidity of the heart. Many of the so- called tachycardias are really instances of auricular fibrillation or flutter. Some persons normally have a pulse and heart too rapid; children more or less constantly have a heart beat of from 90 to 100. Women have more rapid heart action than men, and it becomes more rapid with their varying functions, specifically increasing its rapidity before, and perhaps during, menstruation. Many patients have a rapid heart action with the slightest increase in temperature and in any fever process. Some have a rapid heart action after the least exertion without any cardiac lesion or assignable excuse for such rapidity. Others have a rapid heart with mental activity and excessive excitement. Therefore in deciding that a heart is abnormally rapid one must individualize the patient.

During or after illness many patients are said to have palpitation when the real cause is an unhealed myocarditis. Tuberculosis almost invariably causes increased heart action, even when there is no fever. All high fever increases the heart's action, but not so markedly in typhoid fever as in other fevers; in fact, the heart in typhoid fever, during the early stages, is apt to be slower than the temperature would seem to call for. In anemia when the patient is active the heart is generally rapid. The rapid heart from cardiac disease has already been considered. For the palpitation or rapid heart Just described there is little necessity for other treatment than what the acute or chronic condition would call for. With proper management the condition will improve unless the patient has an idiosyncrasy for intermittent attacks of slightly rapid heart, as from 100 to 120 beats per minute.

A permanently rapid heart, when the patient has no heart lesion and is at rest, is generally due to hypersecretion of the thyroid, which will be discussed later. Paroxysmal tachycardia is a name applied to very rapid heart attacks in persons who are more or less subject to their recurrence. They may occur without any tangible excuse, and are liable to occur during serious illness, after a large meal, after a cup of tea or coffee, or after taking alcohol. The heart may beat as rapidly as from 150 to 200 times a minute, or even more, with no other symptoms than a feeling of constriction or tightness in the chest, an inability to respire properly and a feeling of "air hunger." The patient almost invariably must sit up, or at least have his head raised. Attacks of cardiac delirium (often auricular fibrillation) may occur with serious lesions of the heart, as valvular disease or sclerosis, but paroxysmal tachvcardia occurs in certain persons without any tangible cardiac excuse. The auricles of the heart may act more energetically than normal, and precede as usual the ventricular contraction; or the auricles and ventricles may contract almost together—a so-called "nodal" type of contraction. Rarely does a patient die of paroxysmal tachycardia. The length of time the attack may last varies from a few minutes to an hour, or even for a day or more.

MANAGEMENT

There is no specific treatment for paroxysmal tachycardia. What is of value in one patient may be of no value in another; in fact, drugs are rarely successful in ameliorating or preventing the condition. Patients who are accustomed to these attacks often learn what particular position or management stops the attack.