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

CAFFEIN

Caffein can irritate the heart and cause irregularity and tachycardia, especially in certain persons. In fact, some can never take a single cup of coffee without having an attack of palpitation, and many times when coffee and tea have been unsuspected by the patient as the cause of cardiac irritability, their removal from the diet has stopped the symptoms, and the heart has at once acted normally.

Caffein is a stimulant and tonic to the heart, increasing its rapidity and the strength of the contractions. It is also a cerebral stimulant, one of the most active that we possess among the drugs. It increases the blood pressure, principally by stimulating the vasomotor center and by increasing the heart strength. It acts as a diuretic, not only by increasing the circulatory force and blood pressure, but also by acting directly on the kidney. This action on the kidney contraindicates the use of caffein in any form, except in rare instances, when there is acute or chronic nephritis. The increased blood pressure caused by caffein also contraindicates its use when there is hypertension. Caffein first accelerates the heart and later may slow it and strengthen it; but if the dose is large or too frequently repeated, the apex of the heart ceases to relax properly and there is an interference with the contraction of the ventricles, the heart muscle becomes irritable, and a tachycardia may develop.

Therefore when a heart has serious lesions, whether of the myocardium or of the valves, with compensation only sufficient, the action of caffein in any form is contraindicated. The fact that it raises the blood pressure, thus increasing the force against which the heart must act, and that it irritates the heart muscle to more sturdy or irregular contraction, indicates that a patient with a heart lesion or with a nervously irritable heart should never drink tea and coffee or take caffein in any beverage.

Many patients cannot sleep for many hours after they have taken coffee or tea, as the cerebral stimulation of caffein is projected for hours after its ingestion. Caffein does not absorb so quickly and therefore does not act so quickly when taken in the form of tea and coffee as it does when taken as the drug or as a beverage which contains the alkaloid. Persons who are nervously irritable, excited and overstimulated cerebrally, with or without high blood pressure, should not take this cerebral and nervous excitant. This is true in early childhood and in youth, and continues true as age advances, in most persons. It is a crime to present caffein as a soda fountain beverage to children and young persons when the excitement of the age is such as already to overstimulate all nervous systems and all hearts.

A considerable majority of persons over 40 learn that they cannot drink tea or coffee with their evening meal without finding it difficult to sleep. Such patients, of course, should omit this stimulant. Some patients have already recognized this fact and its cause; others must be told. The majority of adults are probably no worse and may be distinctly benefited by the morning cup of coffee and the noon coffee or tea, provided the amount taken is not large. It seems to be a fact that the drinking of coffee is on the increase, especially as to frequency. Certainly the five o'clock tea, with women, is on the increase, and we must deal with one more cerebral and nervous excitant in our consideration of what we shall do to slow this rapid age.

TOBACCO

In spite of the fact that a large number of men today do not smoke, more and more frequently every clinician has a patient who smokes too much. The accuracy with which he investigates these cases depends somewhat on his personal use of tobacco, and therefore his leniency toward a fellow user. Perhaps the percentage of young boys who smoke excessively is larger than the percentage of men. Whether or not the term "excessive" should be applied to any particular amount of tobacco consumed depends entirely on the person. What may be only a large amount for one person may be an excessive amount for another, and even one cigar a day may be too much for a person is as much for him as five or more cigars for another. If one is to judge by the internal revenue report it will appear that, in spite of the public school instruction as to the physiologic action of tobacco and its harm, and in spite of the antitobacco leagues, the consumption of tobacco is enormously on the increase.

Alexander Lambert [Footnote: Lambert, Alexander: Med. Rec., New York, Feb. 13, 1915] in studying periodic drinkers and alcoholics, finds that most patients are suffering from chronic tobacco poisoning, and if they stop their smoking, their drinking sometimes ceases automatically.

Howat [Footnote: Howat: Am. Jour. Physiol., February, 1916.] has shown that nicotin causes serious disturbances of the reflexes of the skin of frogs.