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Acute Dilatation Of The Heart In Acute Disease
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The Heart In Pneumonia
Source: Disturbances Of The Heart
As pneumonia heads the list of the causes of death in this country,
and as the heart fails so quickly, sometimes almost in the beginning
in pneumonia, a special discussion of the management of the heart in
this disease is justifiable.
Acute lobar pneumonia may kill a patient in twenty-four or forty-
eight hours; lie may live for a week and die of heart failure or
toxemia, or he may live for several weeks and die of cardiac
weakness. If he has double pneumonia be may die almost of
suffocation. It is today just as frequent to see a slowly developing
and slowly resolving pneumonia as to see one of the sthenic type
that attacks one lobe with a rush, has a crisis in a seven, eight or
nine days, and then a rapid resolution. In fact the asthenic type,
in which different parts of the lung are involved but not
necessarily confined to or even equivalent to one lobe, is perhaps
the most frequent form of pneumonia.
The serious acute congestion of the lung in sthenic pneumonia in a
full-blooded, sturdy person with high tension pulse may be relieved
by cardiac sedatives, vasodilators, brisk purging, or by the
relaxing effect of antipyretics. Venesection is often the best
When the sputum almost from the first is tinged with venous blood,
or even when the sputum is very bloody, of the prune-juice variety,
the heart is in serious trouble, and the right ventricle has
generally become weak and possibly dilated. The heart may have been
diseased and therefore is unable to overcome the pressure in the
lungs during the congestion and consolidation.
There is a great difference in the belief of clinicians as to the
best treatment for this condition. It would seem to be a positive
indication for digitalis, and good-sized doses of digitalis given
correctly, provided always that the preparation of the drug used is
active, are good and, many times, efficient treatment. Small doses
of strychnin may be of advantage, and camphor may be of value. In
the condition described, however, reliance should be placed on
digitalis. Later in the disease when the heart begins to fail,
perhaps the cause is a myocarditis. In this condition digitalis
would not work so well and might do harm. It is quite possible that
the difference between digitalis success and digitalis nonsuccess or
harm may be as to whether or not a myocarditis is present.
If the expectoration is not of the prune-juice variety and is not
more than normally bloody, or in other words, typically pneumonic,
and the heart begins to fail, especially if there is no great amount
of consolidation, the left ventricle is in trouble as much as the
right, if not more. In this case all of the means described above
for the prevention of any dilatation of the heart will be means of
preventing dilatation from the pneumonia, if possible. The treatment
advisable for this gradually failing heart is camphor; strychnin in
not too large doses, at the most 1/10 grain hypodermically once in
six hours; often ergot intramuscularly once in six hours for two or
three doses and then once in twelve hours; plenty of fresh air, or
perhaps the inhalation of oxygen. Oxygen does not cure pneumonia,
but may relieve a dyspnea and aid a heart until other drugs have
time to act.
If there is insomnia, morphin in small doses will not only cause
sleep, but also not hurt the heart. In the morning hours of the day
the value of caffein as a cardiac stimulant and vasocontractor,
either in the form of caffein or as black coffee, should be
remembered. Strophanthin may be given intravenously.
One of the greatest cares in the treatment of heart failure in
pneumonia should be not to give too many drugs or to do too much.
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