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Source: 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
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
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
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.
Next: Treatment Of Broken Compensation
Previous: Paroxysm Management