Stokes Adams Treatment

Categories: Uncategorized
Sources: Disturbances Of The Heart

The treatment of true Stokes-Adams disease is unsuccessful. If

general arteriosclerosis is present, that condition should be

treated. Digitalis would seem almost invariably contraindicated,

although it is of value in extrasystoles without heartblock, or in

conditions which are not Stokes-Adams disease; but if this disease

was considered present, digitalis would probably do harm. Sometimes

strychnin is of benefit.



Atropin has sometimes caused stimulation of the heart to more normal

rapidity. Its benefit is generally only temporary, as most patients

cannot take atropin regularly without having it cause a disagreeable

drying of the throat and skin, a stimulation of the brain, and an

undesired raising of the blood pressure, to say nothing of its

action on the eyes.



The only value of the nitrites is when the blood pressure is high

and the nitrite action is desired on that account.



Coffee or caffein often causes these hearts to become irritable; it

certainly raises the blood pressure, and therefore is not generally

advisable. Both tea and coffee should generally be prohibited.



During the acute faint attack, camphor is one of the best

stimulants. Alcohol may be of benefit. If syphilis is a cause of the

condition, iodids are always valuable. If syphilis is not a cause

and arteriosclerosis is present, small doses of iodid given for a

long period are beneficial, although it may not much reduce the

blood pressure or decrease the plasticity of the blood. Iodid is a

stimulant to the thyroid gland, and therefore it is on this account

valuable.



An excellent stimulant to the heart is thyroid secretion or thyroid

extract. Theoretically thyroid extracts should be the treatment for

a slow-acting heart. It sometimes seems of benefit to these

patients, but it often causes such nervous excitation and

irritability as to preclude its use. The dose of thyroid for this

purpose would be small, about one-fourth to one-half grain of the

active substance three times a day. To be of any value, the

preparation must be good.



Epinephrin has been shown by Hirtz [Footnote: Hirtz: Arch d. mal. du

coeur, February, 1916] to overcome experimental heart block. It is

not clear just how it acts, but it could well be tried in heart

block when the blood pressure is not too high. A few drops of an

epinephrin solution 1:1,000 may be placed on the tongue, and

repeated three times a day, or from 5 to 10 minims of a weaker

solution may be given hypodermically.



The usual precautions against overeating, overdrinking, severe

physical exercise, sudden movements, overuse of tobacco, etc.,

should all be urged on the patient. The disease is sooner or later

fatal, although the patient may live some years. Death is generally

sudden.



It is understood that this disease must he separated from the

condition of bradycardia inherent in a few persons who have a slow

pulse throughout their life, without any untoward symptoms.