Etiology


Categories: Uncategorized
Sources: Disturbances Of The Heart

The cause of an irregularly acting heart in an adult may be organic,

as in the various forms of myocarditis, in broken compensation of

valvular disease, Stokes-Adams disease, coronary disease, auricular

fibrillation, auricular flutter, cerebral disease, and toxemias from

various kinds of serious organic disease. The cause may be more or

less functional and removable, such as tea, coffee, alcohol,

tobacco, gastric indigestion and intestinal toxemia; or it may be

due to functional disturbances of the heart, such as that due to

what has been termed extrasystole, or to irregular ventricular

contractions. A frequent cause of irregular heart action in women,

more especially of increased rapidity, is hyperthyroidism.



There may be an arrhythmia due to some nervous stimulation, probably

through the pneumogastric, so that the pulse varies abnormally

during respiration, being accelerated during inspiration and

retarded during expiration more than is normally found in adults.

This condition is frequent in children, and is noticed in neurotic

adults and sometimes during convalescence from a serious illness.

Nervous and physical rest, with plenty of sleep and fresh, clean air

so that the respiratory center is normally stiniulated, will

generally improve this condition in an adult.



Extrasystoles causing arrhythmia give a more or less regularly

intermittent pulse, while the examination of the heart discloses an

imperfect beat or the extrasystole which is not transmitted or acted

on by the ventricles, and hence the intermittency in the peripheral

arteries. This condition may be due to some toxemia, nervous

irritability, or some irritation in the heart muscle. Good general

elimination by catharsis, warm baths to increase the peripheral

circulation, a low diet for a few days, abstinence from any toxin

which could cause this cardiac irritation, extra physical and mental

rest, sometimes nervous sedatives such as bromids, and perhaps a

lowering of the blood pressure by nitroglycerin, if such is

indicated, or an increase of the cardiac tone by digitalis if that

is indicated, will generally remove the cardiac irritation and

prevent the extrasystoles, and the heart will again become regular.

It should be carefully decided whether there is beginning heart

block or beginning Stokes-Adams disease, in which case digitalis

should not be used. This disease is not frequent, while

extrasystoles of a functional character are very frequent. Sometimes

this functional disease persists without any apparent injury to the

individual as long as the ventricle does not take note of these

extra auricular systoles and does not also become extra rapid. If

the ventricle does contract with this increased rapidity, it soon

wears itself out, and the condition becomes serious.



In this kind of arrhythmia, if there are no contraindications to

digitalis, it is the logical drug to use from its physiologic

activities, slowing the heart by its action on the vagi and causing

a steadier contraction of the heart; clinically this treatment is

generally successful. If digitalis should, however, cause the heart

to become more irritable, it is acting for harm, and should be

stopped.





More

;