Paroxysm Management


Categories: Uncategorized
Sources: Disturbances Of The Heart

The immediate conditions to meet are the rapid fluttering heart, the

nervous excitation and cardiac anxiety, and perhaps the most

important of all, the vasomotor spasm that is often so pronounced.

Physically we have, then, a heart with leaking or constricted

valves; in either case more blood is entering the chambers of the

heart than can be expelled in one contraction, while the peripheral

resistance due to the spasm of the blood vessels, because of fear,

becomes greater every minute and tends still more to interfere with

the peripheral circulation and the complete emptying of the heart of

its surplus blood. Owing to the well known stimulus to distention of

hollow muscular organs, the heart contracts faster and faster.



Soon, by some disarrangement of the inhibitory apparatus, the

pneumogastric nerves, the heart loses its governor, and the beats

increase to even 150 a minute, with irregular contractions, the

blood being sent through the arteries with irregular force, as

evidenced by the varying volume of the pulse. At this time, with or

without cardiac pain, which upsets the rhythm of the heart, the

patient becomes frightened at the feeling of impending demise, and

the cerebral reflexes begin to add to the cardiac difficulty. The

breathing becomes nervously rapid, besides that which is due to the

rapid heart. The chill of fear is added to the already contracted

peripheral vessels, and the surface of the body becomes cold, the

extremities sometimes intensely so. Next it seems as if the strongly

contracted arterioles begin actually to prevent some of the

peripheral circulation, the blood is piled up in the large arteries,

and the venous circulation becomes more and more sluggish, while the

lips, finger nails and forehead become cyanotic. Respiration becomes

more rapid and deep; the inspiration being as strong as possible

with every auxiliary muscle taking part, thus making the negative

pressure in the chest aid in bringing the blood back through the

veins. Part of the extra respiratory stimulus comes from the

imperfectly aerated blood reaching the respiratory center.



Two factors may normally, without treatment, stop these paroxysms,

and the "bad heart turn" may be cured spontaneously. The first of

these is self-control. If the patient does not lose his head, by an

effort of the will he saves himself from becoming nervous or

frightened and therefore escapes the result of mental excitement;

the increased peripheral blood pressure from fear does not occur,

and in a shorter or longer time the heart quiets down. The physician

recognizes this power, and gives his patient immediate assurance

that he will soon be all right; the patient who knows his physician

immediately feels this assurance and is quickly improved.



The second factor in spontaneous cure of the heart attack is

relaxation. The exhaustion from the respiratory muscular efforts,

together with the drowsy condition caused by the cerebral hyperemia

and from the imperfectly aerated blood, causes finally a dulling of

the mental acuity, and the nervous excitement abates, which, with

the exhaustion, gives a relaxation of peripheral arterioles: the

resistance to the flow of the blood is removed, the surface of the

body becomes warm, the heart quiets down by the equalization of the

circulation, and the paroxysm is over.





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