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Treatment Of Endocarditis
Source: 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
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.