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Decannulation After Cure Of Laryngeal Stenosis
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Source: Disturbances Of The Heart
The first decision to be made is what constitutes a slow pulse or
slow heart. A pulse below 58 or 60 beats per minute should be
considered slow, and anything below 50 should be considered
abnormally slow and a condition more or less suspicious. A pulse
from 45 to 50 per minute occasionally occurs when no pathologic
excuse can be found, but such a slow rate is unusual. Before
determining that the heart is slow, it must of course be carefully
examined to determine if there are beats which are not transmitted
to the wrist; also whether a slow radial rate is not due to
intermitence or a heart block. Auricular fibrillation, while
generally causing a rapid pulse (though by no means all beats are
transmitted to the peripheral arteries), tray cause a slow pulse
because some of the contractions of the heart are not transmitted.
While any pulse rate below 50 should be considered abnormal and more
or less pathologic, still a pulse rate no lower than 60 may, be very
abnormal for the individual. For athletes and those who work hard
physically, a slow pulse is normal. Such hearts are often not even
normally stimulated by high fever, so that the pulse is unusually
slow, considering the patient's temperature, unless inflammation of
the heart has occurred.
Some chronic diseases cause a slow pulse; this is especially true of
chronic interstitial nephritis. In fact, it may be stated that any
disease or condition which increases the blood pressure generally
slows the pulse, unless the heart itself is affected. This is true
of hypertension, of arteriosclerosis, of nicotin unless the heart
has become injured, and often of caffein, unless it acts in the
individual as a nervous stimulant. Chronic lead poisoning causes a
slow pulse on account of the increased blood pressure.
A slow pulse may occur during convalescence from acute infections,
such as typhoid fever and pneumonia, and sometimes after septic
processes. While it may not be serious in these conditions, it
should always be carefully watched, as it may show a serious
While weakness generally and myocarditis, at least oil exertion or
nervous excitation or after eating, cause a heart to be rapid, still
such a heart may act sluggishly when the patient is at rest, so that
he feels faint and weak and disinclined to attempt even the
slightest exertion. In such a condition calcium, iron and strychnin,
not too frequently or in too large doses, and perhaps caffein, are
indicated. Camphor is always a valuable stimulant, more or less
frequently administered, during such a period of slow heart. This
slow heart sometimes occurs after rheumatic fever; it is quite
frequent after diphtheria, and may show a disturbance of the vagi.
Although the prognosis of such slow hearts after serious illness is
generally good, a heart that is too rapid after illness is often
more readily brought to normal by proper management than a heart
which is too slow. Either condition needs proper treatment and
It is well recognized that serious, almost major hysteria may be
present and the heart not only not be increased, but it may even be
slowed. The heart in this condition of course requires no treatment.
In cerebral disturbances, especially when there is cerebral
pressure, and more particularly if there is pressure in the fourth
ventricle, the pulse may be much slowed. It is often slowed in
connection with Cheyne-Stokes respiration. It may be very slow after
apoplexy, and when there are brain tumors. It is often much slowed
in narcotic poisoning, especially in opium, chloral and bromid
poisoning. Serious toxemia from alcohol may cause a heart to be very
slow. It is more likely, however, to cause a heart to be rapid,
unless there is actual coma.
A frequent condition causing a slowing of the heart is the presence
of bile in the blood, typically true of catarrhal jaundice. Uremic
poisoning and acidemia and coma of diabetes tray cause a pulse to be
Not infrequently after parturition the heart quiets down from its
exertion to a rate below normal. If the urine is known to be free
from albumin and casts, and there are no signs of impending
eclampsia, the slow pulse is indicative of no serious trouble; but
the urine should be carefully examined and a possible uremia or
other cause of eclampsia carefully considered. Sometimes with
serious edema and after serious hemorrhage the heart becomes very
slow, unless some exertion is made, when it will beat more rapidly
than normal. This probably represents a diminished cardiac
The cardiac lesions which cause a pulse to be slow are sclerosis or
thrombosis of the coronary arteries, fatty degeneration of the
myocardium, and Stokes-Adams disease.
It is seen, therefore, that when a pulse is slower than normal, even
below 65 beats per minute, the cause should be sought. If no
functional or pathologic excuse is discovered, it must be considered
normal, for the individual, and, as stated above, even 58 or 60
beats per minute are in many instances normal for men. This is
especially true with beginning hypertension, and may be true in
young men who are athletic or who are oversmoking but are not being
poisoned by the nicotin, as shown by the fact that their hearts are
not rapid, that they are not having cardiac pains, that they do not
perspire profusely, and that they do not have muscle cramps. A pulse
of from 50 to 55 is likely to be seriously considered by an
insurance company in deciding the advisability of the risk, and
below 50 must be considered as abnormal.
Next: Bradycardia Symptoms
Previous: Pulsus Alternans