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Paroxysmal Tachycardia Management
Source: Disturbances Of The Heart
There is no specific treatment for paroxysmal tachycardia. What is
of value in one patient may be of no value in another; in fact,
drugs are rarely successful in ameliorating or preventing the
condition. Patients who are accustomed to these attacks often learn
what particular position or management stops the attack.
Sometimes a patient rises and walks about. Sometimes an ice-bag over
the heart will stop the attack.
If there is no serious illness present, and no serious cardiac
disease causing the condition, and a patient is known to have an
overloaded stomach or bowels, an emetic or a briskly acting
cathartic is the best possible treatment. The attack often
terminates as suddenly as it begins, without leaving any knowledge
as to which particular treatment has been beneficial. A patient who
is well and has an attack of tachycardia should be allowed to assume
the position which he finds to give him the most comfort, and to use
the means of stopping his attack which lie has found the most
successful. In the absence of his success or of his knowledge of any
successful treatment, a hypodermic injection of 1/6 or even 1/4
grain of morphin sulphate is often curative. Atropin should not be
given, as it may increase the cardiac disturbance. If an attack
lasts more than an hour or so, one of the best treatments is the
bromids, which should be given either by potassium or sodium bromid
in a dose of 2 or 3 gm. (30 or 45 grains) at once. Sometimes one
good-sized dose of digitalis may be of benefit, but it is often
disappointing, and unless there is a valvular lesion with signs of
broken compensation, it is rarely indicated. It should also be
remembered that, if the patient is receiving digitalis in good
dosage for broken compensation, tachycardia may be caused by an
overaction of the digitalis. Such overaction would be indicated by
previous symptoms of nausea, vomiting, intestinal irritation, a
diminished amount of urine, headache and a tight, bandlike feeling
in the head, cold hands and feet, and a day or two of very slow
pulse. If none of these symptoms is present, though a patient has
received digitalis for broken compensation, a tachycardia occurring
might not contraindicate digitalis, as much of the digitalis on the
market is useless; and a patient may not actually have been
obtaining digitalis action.
If the tachycardia occurs in a patient with arteriosclerosis,
especially if there is much cardiac pain, nitroglycerin is of
advantage; also warm foot-baths. If there is prostration and a
flaccid, flabby abdomen, a tight abdominal bandage may be of
Gastric flatulence, while perhaps not a cause of the tachycardia, is
liable to develop and be a troublesome symptom. Anything that causes
eructations of gases is of benefit, as spirit of peppermint,
aromatic spirit of ammonia or plain hot water. If there is
hyperacidity of the stomach, sodium bicarbonate or milk of magnesia
will be of benefit.
The ability of some patients to stand a rapid heart action without
noting it or being incapacitated by it is astonishing. It may
generally be stated that a rapid heart is noted, and a pulse above
120 generally prostrates, at least temporarily, a patient who is
otherwise well, provided the cause is anything but hyperthyroidism.
A patient who has hypersecretion of the thyroid will be perfectly
calm, collected, often perhaps not seriously nervous, and, with a
heart beating at the rate of 140, 150, 160 and even 200 per minute,
will state that she has no palpitation now, although she sometimes
has it. A heart thus fast, with a patient not noting it and not
prostrated by it, is almost diagnostic of a thyroid cause.
Some patients, both men and women, cannot take even a small cup of
tea or coffee without an attack of paroxysmal tachycardia. Such
patients, of course, quickly learn their limitations.
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