Paroxysmal Tachycardia Management


Categories: Uncategorized
Sources: 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

benefit.



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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