Treatment


Categories: Uncategorized
Sources: Disturbances Of The Heart

The treatment of a suspected coronary sclerosis is the same as that

of general arteriosclerosis--primarily the elimination of anything

which tends to cause high tension or to produce chronic

endarteritis. When either general or local arteriosclerosis is

present, the treatment which should be inaugurated comprises

anything which would tend to inhibit the endarteritis and the

classification--necessary periods of rest, the interdiction of all

physical effort or physical strain, and the regulation of the diet,

digestion and elimination. Perhaps there is no greater preventive of

the advance of this disease than a diet considerably less than would

be suitable for the same person when in perfect health and at his

regular work. The amount of protein especially should be reduced,

and the meal hours should be regular. Ordinarily all tea, coffee and

tobacco should be forbidden, and alcohol should be allowed only to

the aged, if allowed at all.



It has long been considered that iodin would inhibit abnormal

connective tissue growth. Iodin most readily reaches the blood as

sodium or potassium iodid. Large amounts of iodin are not needed to

saturate the requirements of the system for iodin, from 0.1 to 0.2

gm. (1 1/2 to 3 grains) preferably of sodium iodid, twice a day,

after meals given with plenty of water, being sufficient; but it

should be continued in one or two doses a day not only for weeks,

but for months. Whether this iodid or iodin acts per se, or acts by

stimulating the thyroid gland to increased activity and therefore to

more normal activity, so that it is the thyroid secretion which is

of benefit, it is difficult to decide. In view of the fact that in

advanced years the thyroid is always subsecreting, and after the

very diseases which cause arteriosclerosis or during the diseases

which cause arterinsclernsis the thyroid is generally subsecreting,

it would appear that the value of iodin is in its effect in

stimulating the thyroid gland.



If a small amount of thyroid secretion is evidenced by other

symptoms, thyroid extract should be given. The dose need not be

large, and should be small, but should be given for a considerable

length of time. If the patient seems to be improving on small doses

of iodid, however, and the thyroid is supposed not to be very

deficient, it is better not to administer thyroid extract, unless

the patient is obese.



A serum treatment given intravenously, hypodermically, by the mouth,

and by the rectum was inaugurated some years ago (1901 and 1902).

and is known as the "Trunecek serum." This first consisted of sodium

sulphate, sodium chlorid, sodium phosphate, sodium bicarbonate and

potassium sulphate in water in such amounts as to stimulate the

blood plasma. Later small amounts of calcium and magnesium phosphate

were added to the solution to be injected. These injections seemed

to lower the blood pressure, but it is doubtful whether they have

any greater ability than a proper regulation of the diet to inhibit

arteriosclerosis. At any rate, these injections are but seldom used.



An important means of inhibiting disturbance from any

arteriosclerosis which should be employed when possible is the

climate treatment. Warm, equable climates, in which there are no

sudden radical changes, are advantageous when coronary sclerosis is

suspected, and warm climates are valuable in promoting the

peripheral circulation and lowering the blood pressure in

arteriosclerosis. These patients always require more heat than

normal persons, always feel the cold severely, and their hearts

always have much less disturbance, fewer irregularities and fewer

attacks of pain during warm weather than during cold weather.



Simple hydrotherapeutic measures are also necessary for these

patients, but baths should not be used to the point of causing

debility and prostration. Applications of cold water in any form are

generally inadvisable. Very hot baths are also inadvisable; but

pleasantly warm baths, taken at such frequency as found to be of

benefit to the individual, relax the peripheral circulation relieve

the tension of the internal vessels, lessen the work of the heart,

and promote healthy secretion of the skin, the skin of

arteriosclerotic patients often being dry. This dry skin is

especially frequent if there is any kidney insufficiency, which so

soon and so readily becomes a part of the arteriosclerotic process.



If the patient is old, small doses of alcohol may act

physiologically for good. In these arteriosclerotic patients the

activities of alcohol should be considered from the drug point of

view, not from that of all intoxicating beverage. Other drugs are

considered in the discussion of hypertension.



If the heart actually fails, the treatment becomes that of chronic

myocarditis and of dilatation.



Not infrequently in sclerosis of the arteries, especially of the

coronary arteries, the blood pressure is not high, but low, and the

heart is insufficient. In such patients cardiac tonics may be

considered, but they must be used with great care. Digitalis may be

needed, but it should be tried in small doses. It often makes a

heart with arteriosclerosis have severe anginal attacks. On the

other hand, if the heart pangs or heart aches and the sluggish

circulation are due to myocardial weakness without much actual

degeneration, digitalis may be of marked benefit. The value of

digitalis in doubtful instances will be evidenced by an improved

circulation in the extremities, a feeling of general warmth instead

of chilliness and cold, an increased output of urine, and less

breathlessness on slight exertion.





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