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Auricular Fibrillation Treatment
Source: Disturbances Of The Heart
The condition may be stopped by relieving the heart and circulation
of all possible toxins and irritants, and by the administration of
digitalis. One attack is frequently followed by others, perhaps of
longer duration. Occasionally, however, the patient may be observed
for many years without the condition again being present. If the
pulse, in spite of treatment, is permanently irregular, and
auricular insufficiency is permanent, the patient is of course in
danger of cardiac failure; but still he may live for years and die
of some other cause than heart failure. The prognosis is better when
the pulse is not rapid--below a hundred. This shows that the
ventricles are not much excited and do not tend to wear themselves
Any treatment which lowers the heart rate is of advantage, such as
the stopping of tea and coffee, and the administration of digitalis,
together with rest and quiet.
While large doses of digitalis are advised, and large doses are
given as soon as a patient with auricular fibrillation comes under
treatment, such large dosage is dangerous practice. Many patients
may be cured or may survive fluidram doses of the official tincture,
but such large doses should never be used unless it is decided,
after consultation, that, though dangerous, it may be a life-saving
If a patient has not been receiving digitalis, it is best to begin
with a small close and gradually increase the dosage, rather than to
give the heart a sudden shock from an enormous dose of digitalis.
The preparation selected must be the best obtainable, but the exact
dosage of any preparation can be determined only by its effect, as
all preparations of digitalis deteriorate sooner or later. It is
well to administer digitalis at first three times a day, then as
soon as its action is thoroughly established, reduce to twice a day,
and later to once a day, in such dosage as is needed to make a
profound impression on the heart. The first dose may be from 5 to 10
drops, and the dosage may be increased by 5 drops at each dose,
until improvement is obtained. If the patient is in a momentary
serious condition and liable to die of heart failure, it is doubtful
if digitalis pushed at that time will be of benefit. On the other
hand, if, after consultation, it is deemed advisable to give half a
fluidram or more of digitalis at once, it is justifiable. It should
be emphasized that the proper dose of digitalis is enough to do the
work. If within a few days there is no marked improvement, the
prognosis is not good. Also, if the digitalis causes cardiac pain
when such was not present, or increases cardiac pains already in
evidence, and causes a tight feeling in the chest, nausea or
vomiting, or a diminished amount of urine, and a tight, bandlike
feeling in the head, digitalis is not acting well, and should be
stopped, or the dose is too large. Also, if there is kidney
insufficiency, or if the digitalis diminishes the output of urine,
it generally should be stopped.
If the blood pressure is high, and perhaps almost always, even in
those who are accustomed to the use of it, tobacco should be
stopped. Tea and coffee should always be withheld from such
The food and drink should be small in amount, frequently given, and
should be such as especially to meet the needs of the individual,
depending entirely on his general condition and the condition of his
Next: Pulsus Alternans
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