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At other times he may be conscious of irregular, strong throbs or pulsations of the heart, as such hearts often give an occasional extra sturdy ventricular contraction. These he notes. Real attacks of tachycardia may be superimposed on the condition. Sooner or later, however, if the condition is not stopped, cardiac weakness and decompensation, with all the usual symptoms, occur.
If the auricular fibrillation is superimposed, or is followed by dilated ventricles and decompensation, the prognosis is bad, although the condition may be improved. In other words, auricular fibrillation added to these conditions is serious, but still, many times a patient may be greatly improved by rest, digitalis, careful diet, proper care of the bowels, etc.
Subsequently, as the disease advances, if the patient does not die of angina pectoris, apoplexy or uremia, the symptoms of cardiac decompensation will develop. As the heart begins to fail, a dilatation of the right ventricle causes passive congestion of the kidneys, and the chronic interstitial nephritis may progress more rapidly.
It is due to a diminished contractile power of the heart when the heart muscle has become weakened and a more or less rapid heart action is present. Jour. Med. He finds that it frequently occurs with Cheyne-Stokes respiration, and continues until death. He also finds that the condition is not uncommon in dilated hearts, especially in mitral disease, and with other symptoms of decompensation.
The treatment is rest in bed and digitalis, but White found that in only four patients out of fifty-three so treated was the alternating pulse either "diminished or banished." In a word, the only treatment is that of decompensation and a dilated heart, and when such a condition occurs and is not immediately improved, the prognosis is bad, under any treatment.
It will be seen that alcohol, except possibly in a single dose occasionally, or for some special reason, is rarely indicated in decompensation.
From his investigations he concludes that a venous pressure of 20 cm. of water is a danger limit between compensation and decompensation of the heart, and a rise above this point will precede the clinical signs of decompensation. Hooker also found that there are daily variations of venous pressure from 10 to 20 cm. of water, with an average of 15 cm., while in sleep it falls 7 or 8 cm.
The onset of dyspnea, with a rapid pulse, should lead one to suspect pulsus alternans when such a condition occurs in a person over 50 with cardiovascular-renal disease, arid with signs of decompensation, and also when such a condition occurs with a patient who has a history of angina pectoris.
As previously urged, not too much fluid, even milk, though it digest perfectly, should be given, as the greater the amount of fluid the greater the amount of work thrown on the heart. A patient who has developed decompensation has always imperfect elimination. The skin, bowels and kidneys do not act sufficiently or well. The circulation in the skin is sluggish.
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