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Source: Disturbances Of The Heart
Whether any drug should be used which acts directly on the heart is
often a question for decision. As endocarditis is generally
secondary to some acute disease, the patient has become weakened
already, and the circulation is not sturdy; therefore such a drug as
aconite is probably never indicated. The necessary diminished diet,
catharsis, hypnotic, salicylic acid and alkalies all tend to quiet
the circulation and diminish any strenuosity of the heart that may
be present. Unfortunately, during fever processes, digitalis in
ordinary doses rarely slows the heart; and while it might slow the
heart if given in large doses, it would also cause too powerful
contractions of the ventricles. Digitalis is inadvisable if there is
much endocardial inflammation, and especially if there is supposed
or presumed to be acute myocardial inflammation. If a patient had
already valvular disease from a previous endocarditis, and during
this attack insufficiency of the heart was evidenced by pendent
edemas, digitalis Should be administered; but it probably should not
be given to other patients during the acute period of inflammation.