Paroxysm Drugs


Categories: Uncategorized
Sources: Disturbances Of The Heart

The part the nervous system plays in this paroxysm is shown by the

good result obtained from injections of morphin, even when there is

no pain; hence the action of morphin is directly in line with the

natural resolution of the symptoms: it quiets the nervous system,

causes drowsiness, relaxes spasm, and thus causes increased

peripheral circulation; many times this is the only treatment

necessary.



During these heart attacks it is more than useless to administer any

drug by the stomach, as in this condition there will be no

absorption, even if there is no vomiting.



While morphin is generally indicated, as just suggested, a very

large dose should not be given, lest the activity of the respiratory

center be impaired (it is already in trouble), and undoubtedly death

may easily be caused by an overaction of morphin during these heart

attacks. The addition of atropin to the morphin will prevent

depression from the morphin. Also, atropin sometimes quiets cardiac

pain, but it will not steady the heart, may irritate it, and will

increase vasomotor tension, although peripheral nerve irritation may

be diminished. Hence a fair dose of morphin hypodermicaly with a

small dose of atropin, if respiratory depression is feared, is a

physiologic method of bettering the condition. In this kind of heart

attack a drug which often acts well is nitroglycerin. It may be

given hypodermically in a dose of from 1/200 to 1/100 grain, or a

tablet may be dissolved on the tongue, and the dose be repeated once

or twice at fifteen-minute intervals, until there is throbbing in

the forehead, which shows that a sufficient amount of the drug has

been administered. This headache will generally not last long. In

the meantime the peripheral blood vessels are relaxed, the surface

of the body becomes warm, the heart quiets, and the attack is over.

To hasten the action of nitroglycerin (that is, to equalize the

circulation) a hot foot-bath is often valuable. Amyl nitrite may be

inhaled with the same object in view, but the action is very

intense, the prostration often severe, and unless there is angina

pectoris, nitroglycerin is much better.



The symptoms of a heart attack may not be quite those described

above; they may be those of sudden dilatation or semiparalysis of

the heart, in which the prostration is intense and the patient is

unable to sit up, although he may be leaning against several

pillows. There is dyspnea, but the patient cannot aid respiration

with the auxiliary muscles by holding the arms and shoulders tense

or obtaining support from the aruls; in fact, the arms are almost

strengthless. The surface of the body may be warm, and the arms may

be warm except the hands; the feet, ankles and legs may be cold.

There is generally more or less cyanosis, although the face may be

pale. The finger nails often show venous stasis. In these cases the

blood pressure is subnormal, the pulse may be hardly perceptible,

and there is none of the tension of the body from fear. The patient

may be fearful, but lie is completely collapsed. Such an attack may

occur suddenly in a heart that is perfectly compensating, or it may

accompany general edemas and dropsies.



If the emergency is excessively urgent, the lungs filling up with

blood, moist rales beginning to occur, and frothy and blood-tinged

sputum being coughed up, venesection may be indicated; combined with

proper hypodermic medication it may save life, and does at times. In

fact, a patient who shows every sign of fatal cardiac collapse may

be saved. (one of the best drugs to administer to such patient is an

aseptic ergot, injected intramuscularly.) The drug of all drugs for

future action (as it will not act immediately) is digitalis, given

hypodermically.



Whether digitalis shall be given at all, or how large the dose shall

be depends on whether or not the patient has been taking digitalis

in large quantities.



He may already be overpowered with digitalis. In that case it would

be contraindicated.



Stroplianthin, especially when given intravenously, has been found

to be a quickly acting circulatory stimulant. The dose of

strophanthin, Merck, ranges from 1/500 to l/200 grain. The

intravenous dose of strophanthin, Thoms, is about 1/130 grain. It

should not be repeated within a day or two, if at all. Ampules of

strophanthin in solution for intravenous use are now available.



Atropin in a dose of 1/150 grain, and strychnin in a dose of 1/40 or

1/30 grain are valuable aids in stimulating the circulation under

these conditions. The atropin should not be repeated. The strychnin

may be repeated in three, four or five hours, depending on the size

of the previous close.



Of all quickly acting stimulants, none is better than camphor in

saturated solution in sterile oil as may be obtained in ampules.

Alcohol is absolutely contraindicated in the latter condition. In

the former kind of heart attack, vasodilation from a large close of

whisky or brandy may be of value. The dose should be large to cause

immediate increased peripheral circulation, dilation, and even a

little stupefaction of the central nervous system, and it may be

effectual in a way not dissimilar to the action of morphiti.





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