Paroxysmal Tachycardia, Part 2

Disturbances of the Heart
by Oliver T. Osborne, M.D.

(Page 20 of 22)

Gastric flatulence, while perhaps not a cause of the tachycardia, is liable to develop and be a troublesome symptom. Anything that causes eructations of gases is of benefit, as spirit of peppermint, aromatic spirit of ammonia or plain hot water. If there is hyperacidity of the stomach, sodium bicarbonate or milk of magnesia will be of benefit.

The ability of some patients to stand a rapid heart action without noting it or being incapacitated by it is astonishing. It may generally be stated that a rapid heart is noted, and a pulse above 120 generally prostrates, at least temporarily, a patient who is otherwise well, provided the cause is anything but hyperthyroidism. A patient who has hypersecretion of the thyroid will be perfectly calm, collected, often perhaps not seriously nervous, and, with a heart beating at the rate of 140, 150, 160 and even 200 per minute, will state that she has no palpitation now, although she sometimes has it. A heart thus fast, with a patient not noting it and not prostrated by it, is almost diagnostic of a thyroid cause.

Some patients, both men and women, cannot take even a small cup of tea or coffee without an attack of paroxysmal tachycardia. Such patients, of course, quickly learn their limitations.

Hyperthyroidism

The presence of a well marked case of exophthalmic goiter is not necessary for the secretion of the thyroid to be increased sufficiently to cause tachycardia; in fact, an increased heart rapidity in women often has hyperthyroidism as its cause. The thyroid gland hypersecretes in women before every menstrual period and during each pregnancy, and with an active, emotional, nervous life, social excitement, theaters, too much coffee, and, unfortunately today among women, too much alcohol, it readily gives the condition of increased secretion; and the organ that notes this increased secretion the quickest is the heart.

The tachycardia of a developed exophthalmic goiter is difficult to inhibit. Digitalis is of no avail, and no other single medicinal treatment is of any great value. The tachycardia will improve as the disease improves. On the other hand, nothing is snore serious for this patient than her rapid heart, and if it cannot be soon slowed, operative interference is absolutely necessary. If the rapid heart continues until a myocarditis has developed and a weakening of the muscle fibers occurs, or dilatation is imminent or has actually occurred, operative interference is serious, and most patients under these conditions die after a complete operation, that is, the removal of from one half to two thirds of the thyroid. In such cases the only excusable operative interference is the graded one, namely, the tying of first one artery and then another of the thyroid to inhibit the blood supply to the gland in order that it may not furnish so much secretion. If the heart then improves, a more radical operation may be done without much serious danger. Therefore the working rule should be that, if a heart does not quickly improve under medical management, operative interference should not be delayed until the heart has become degenerated.

If tachycardia is the only serious symptom present in a patient who is considered to have hyperthyroidism, it may generally be successfully treated by insistence on quiet, cessation of all physical and exciting mental activities, more or less complete rest, the absolute interdiction of all tear coffee or other caffein- bearing preparations, total abstinence from alcohol, the restriction to a cereal and fruit diet (the withdrawal of all meat from the diet), the administration of calcium, as the calcium glycerophospate in dose of 0.3 gm. (5 grains) in powder three times a day, and for a time, perhaps, the administration of bromids. If the depressing action of bromids on the heart is counteracted by the coincident administration of digitalis, they will act only for good by quieting the nervous system and more or less inhibiting the secretion of the thyroid gland.

If a patient has exophthalmic goiter fully developed, absolute rest in bed, with the treatment outlined above, should soon cause improvement. If it does not, the operative treatment as advised above should be considered. If myocarditis has been diagnosed, the minor operations should be done if the patient does not soon improve. The prolongation of the treatment depends on the condition and the amount of improvement.

If the physician is in doubt as to whether or not this particular tachycardia is caused by hyperthyroidism, the administration of sodium iodid in doses of 0.25 gm. (4 grains) three times a day will make the diagnosis positive within a few days. If the trouble is due to hyperthyroidism, all of the symptoms will be aggravated; there will be more palpitation, more nervousness, more restlessness, more sweating and more sleeplessness. In such cases the iodid should be stopped immediately, of course, and the proper treatment begun.