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Angina Pectoris Management
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Source: 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.
Next: Angina Pectoris