BRADYCARDIA.
The slow action of the heart, to which this title is restricted, is but a sign of various pathological conditions, some of which are situated within, whilst others are outside the organ.
The treatment of those cases of bradycardia which are due to the in fluence of a toxin like that produced in diphtheria, influenza, typhoid fever, gout, jaundice, diabetes, and urzemia, should he eliminatory in principle. It is of primary importance to insure rest in the horizontal position, as the paralysis of the accelerating or the stimulation of the inhibitory mechanism may be sufficient to stop the ventricular contrac tions during movement or exertion of the body. The poisons are certain to be eliminated by the skin, kidneys, and bowel if the patient can be kept alive for a sufficient time by the administration of highly nutritious liquid food, and if Strychnine be employed hypodermically. Hot-air baths administered in the horizontal position, diuretics and mild saline purgatives, followed by general massage, will hasten the elimination of the toxic substances. The strychnine is believed to act as an antidote to the organic poison as well as a tonic to the cardiac muscular fibres, and it is often advisable to combine it with very small doses of Strophanthus given by the mouth. 5 mins. liquor strychnine should be given twice a day by the skin, and 21 mins. tincture of strophanthus every six hours by the mouth. Atropine is also a drug of considerable value when used judic iously; gr. may be injected with each dose of the strychnine, or given with the strophanthus.
The treatment of bradycardia, produced by muscarine (poisonous fungi), lead, alcohol, tobacco and digitalis, is to be conducted upon the - same lines. In gouty cases, Colchicum is clearly indicated in moderate doses, combined with the free use of Citrate of Bicarbonate or Potash.
When there is associated a high degree of tension in the vessels with slowness of the pulse, Nitroglycerin is clearly indicated, hut this type of bradvcardia is usually due to intrinsic cardiac disease of the degeneratiye type, as in — PARoxvsmAr. BRADYCARDIA, OR STOKES-ADAMS SYNDROME.—This form of bradvcardia may be regarded for all practical purposes as identical with " Heart Block." It is most frequently met with during the senile stage of life, and is usually associated with degenerative changes in the auriculo-ventricular strands of Kent, which prevent the transmission of the stimulus (originating in the auricles) to the ventricular walls. The slowness of the pulse-rate, which may fall to twenty or less per minute, is not influenced by Atropine or Amyl. The only available treatment lies in rest and the hypodermic use of Strychnine, with the administration of large doses of Iodides for long periods.
The treatment of bradycardia, caused by increased cranial pressure, and of the form associated with chronic valvular disease and arteriosclerosis, will consist in the use of remedies suited to the primary disease.