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The treatment of heart disease other than by drugs
410 patients
THE
with
no
functional
blood pressure, the of cardiac failure, metabolic rates in i0 per cent below rest normal values output per beat in In the fifth patient
AMERICAN
incapacity
HEART
and
JOURNAL
no arteriosclerosis
had
normal
arterial
remaining three had a systolic hypertension. In the absence the venous pressure was normal. Four patients had basal the lower part of the normal range, the fifth had a metabolism normal. In t.he four-patients with no circulatory failure at for the cardiac output per minute were found. The cardiac these patients were increased 40 to 50 per cent about normal. with circulatory failure in bed, indirect evidence of a decreased
blood flow was obtained. The circulating blood volume was reduced in each of four patients; it was not measured in the fifth. The circulation time was estimated by the histamine reaction method. The cardiac output was estima.ted according to the technic of Field, Bock, Gildea and Lathrop. The increased stroke volume of the heart, the systolic hypertension, the reduced blood volume and possibly the somewhat lowered basal metabolic rate may be considered compensatory responses tending to maintain a constant and adequate blood supply to the tissues during the prolonged diastolic pause consequent upon the slow heart rate. The degree of elevation of the lactic acid and the changes of blood gases following exercise were normal in one patient who had good functional capacity. The authors believe that complete heart-block is not incompatible with a normal life and that the prognosis as to health and life is much more dependent’ on the presence or absence of aeeompanying myoeardial disease than on the block itself.
Cole,
Leslie:
Heart-Block
Following
AelIte
Appendicitis.
Lance&
1: 907,
1931.
Four days following an operation for an attack of acute appendicitis the patient developed irregular pulse which later became slow and which was diagnosed No other cause for the disturbfrom frequent electrocardiograms as heart-bdoek. ance of mechanism could be found. The patient recovered and on the twenty-sixth The most likely explanation is that day the electrocardiogram was quite normal. a mild bacteremia was associated with a subsiding local inflammation in the appendix region and caused a small focal inflammatory lesion in the region of the BundIe of His which interfered temporarily with conduction. Possibly, the pain in the right shoulder and the inflammation in the right eonjunctiva may have been due to similar focal lesions.
White, Paul D.: The Treatment Am. Med. Assn., Ixxxix, 436.
of Heart
Disease Other Than By Drugs.
Jour.
In the treatment of heart disease the most important relief frequently comes from agents other than drugs. Rest and recreation, physical and mental; exercise, climate, psychotherapy, physical therapy, regulation of the diet, and of the fluid ingested, surgical intervention and venesection all have a place of variable importance in the therapy of acute and chronic heart disease. The author points out with particular care the relationship that must be maintained between physician and patient. He points out that often times the physician must in his judgment vary his methods to suit the particular circumstances which exist in the individual patient. Ofttimes hard and fast rules cannot be laid down.
THE
with
no
functional
blood pressure, the of cardiac failure, metabolic rates in i0 per cent below rest normal values output per beat in In the fifth patient
AMERICAN
incapacity
HEART
and
JOURNAL
no arteriosclerosis
had
normal
arterial
remaining three had a systolic hypertension. In the absence the venous pressure was normal. Four patients had basal the lower part of the normal range, the fifth had a metabolism normal. In t.he four-patients with no circulatory failure at for the cardiac output per minute were found. The cardiac these patients were increased 40 to 50 per cent about normal. with circulatory failure in bed, indirect evidence of a decreased
blood flow was obtained. The circulating blood volume was reduced in each of four patients; it was not measured in the fifth. The circulation time was estimated by the histamine reaction method. The cardiac output was estima.ted according to the technic of Field, Bock, Gildea and Lathrop. The increased stroke volume of the heart, the systolic hypertension, the reduced blood volume and possibly the somewhat lowered basal metabolic rate may be considered compensatory responses tending to maintain a constant and adequate blood supply to the tissues during the prolonged diastolic pause consequent upon the slow heart rate. The degree of elevation of the lactic acid and the changes of blood gases following exercise were normal in one patient who had good functional capacity. The authors believe that complete heart-block is not incompatible with a normal life and that the prognosis as to health and life is much more dependent’ on the presence or absence of aeeompanying myoeardial disease than on the block itself.
Cole,
Leslie:
Heart-Block
Following
AelIte
Appendicitis.
Lance&
1: 907,
1931.
Four days following an operation for an attack of acute appendicitis the patient developed irregular pulse which later became slow and which was diagnosed No other cause for the disturbfrom frequent electrocardiograms as heart-bdoek. ance of mechanism could be found. The patient recovered and on the twenty-sixth The most likely explanation is that day the electrocardiogram was quite normal. a mild bacteremia was associated with a subsiding local inflammation in the appendix region and caused a small focal inflammatory lesion in the region of the BundIe of His which interfered temporarily with conduction. Possibly, the pain in the right shoulder and the inflammation in the right eonjunctiva may have been due to similar focal lesions.
White, Paul D.: The Treatment Am. Med. Assn., Ixxxix, 436.
of Heart
Disease Other Than By Drugs.
Jour.
In the treatment of heart disease the most important relief frequently comes from agents other than drugs. Rest and recreation, physical and mental; exercise, climate, psychotherapy, physical therapy, regulation of the diet, and of the fluid ingested, surgical intervention and venesection all have a place of variable importance in the therapy of acute and chronic heart disease. The author points out with particular care the relationship that must be maintained between physician and patient. He points out that often times the physician must in his judgment vary his methods to suit the particular circumstances which exist in the individual patient. Ofttimes hard and fast rules cannot be laid down.