The Heart In Pneumonia


Categories: Uncategorized
Sources: 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

treatment.



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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