Treatment Of Endocarditis


Categories: Uncategorized
Sources: Disturbances Of The Heart

As mild endocarditis rarely occurs primarily but is almost always

secondary to some acute disease, its immediate treatment is only a

slight modification of that of the disease which is causing it. A

complication which is so frequent should always be expected, and

consequently warded off or prevented, if possible. Knowledge of the

diseases which are most liable to cause endocarditis makes frequent

heart examinations a necessity, to note when it arrives. While an

extra heart tire, sleeplessness, and the circulation of unnecessary

toxins from a bad condition of the bowels and from improperly

selected food all make this complication more liable, its occurrence

is, nevertheless, often unpreventable.



The most efficacious preventive pleasures are sleep, rest, the

stopping of pain, prevention of exertion, proper food which does not

cause flatulence or other indigestion, good, sufficient daily

movements of the bowels, the prevention of intestinal distention,

and maintenance of a clean, moist surface of the body, produced by

such sponging and bathing as the temperature demands.



The disease having developed, the indications for treatment are

really few; in fact, the treatment is mostly negative. There is

generally but little local pain; the temperature from simple

endocarditis alone is not high and the acute symptoms tend to abate.



Local Treatment.--Endocarditis having been diagnosed, especially if

there is palpation or pain, an ice bag over the heart is often of

considerable value, but not so efficient as in pericarditis. It

often tends to quiet the heart, and may be of some value reflexly in

slowing the inflammation. If it causes restlessness, however, and

does not lessen the pain (which in some instances it may increase),

it certainly should be stopped. Children, in whom this complication

so frequently occurs, generally do not bear the ice bag well.

Sometimes it may be advisable to substitute warm applications, and

often a great deal of comfort is derived from them, the patient soon

going to sleep. One of the greatest values of either cold or hot

applications is diminution of the discomfort from the cardiac

disturbance, and the stopping of any pain which may be present. If

they do not do this, there is no object in using either cold or

heat.



The discomfort from blisters over the heart during the acute stage

of endocarditis is greater than any good which they can do. In

adults a few small blisters may be used intermittently around the

borders of the heart, after the acute symptoms are over, to act

reflexly on the heart and possibly aid absorption of inflammatory

products. Sometimes improvement seems to follow such treatment; it

certainly can do no harm.



During convalescence, the skin over the heart may be painted with

iodin, repeated often enough to cause stimulation without injuring

the skin; it seems at times to be of value. Various iodin or iodid

ointments have been used, but they probably have no more value than

the administration of small doses of iodid.



Systemic Treatment.--As this complication most frequently occurs

during acute rheumatism, the question arises as to the value or

harmfulness of salicylates and alkaline drugs. With our recent

better understanding of the action on the heart of pure salicylates

(either natural or synthetic saliclic acid, which have been shown to

act identically, if equally pure), we must believe that in any

ordinary dosage they will injure the heart but rarely. While

salicylic acid will not prevent endocarditis, it should he

continued, if it is of benefit with regard to the arthritis. The

indication for its use depends on its effect on the joints. As it

acts at times almost as a specific in rheumatism, it would seem that

it should be of value in the endocarditis caused by rheumatism. On

the other hand, the endocarditis occurs during the second or third

week of acute rheumatism, after the blood has been thoroughly

saturated with salicylic acid. Therefore it certainly does not tend

to prevent rheumatic endocarditis; hence for this complication alone

salicylic acid is not indicated.





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