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Sometimes with serious edema and after serious hemorrhage the heart becomes very slow, unless some exertion is made, when it will beat more rapidly than normal. This probably represents a diminished cardiac nutrition. The cardiac lesions which cause a pulse to be slow are sclerosis or thrombosis of the coronary arteries, fatty degeneration of the myocardium, and Stokes-Adams disease.
It should be carefully decided whether there is beginning heart block or beginning Stokes-Adams disease, in which case digitalis should not be used. This disease is not frequent, while extrasystoles of a functional character are very frequent.
Stokes-Adams disease should be considered as possibly present, and digitalis would be contraindicated and would do harm. A scientific indication as to whether a heart is disturbed through the action of the vagi or whether the disturbance is due to muscle degeneration may be obtained by the administration of atropin. Jour. Med.
It has been found, by studying the pathology of Stokes-Adams disease, as well as by clinically noting with instruments the contractions of different parts of the heart, that these slow heart beats are really due to interruptions of the impulse passing from auricle to ventricle through the bundle of His, and degeneration in this region is generally the cause of Stokes- Adams disease.
Stokes-Adams disease, or the Stokes-Adams syndrome, is a name applied to a combination of symptoms which was described by Stokes in 1846, and had been observed by Adams in 1827. The disease is characterized by bradycardia and cerebral attacks, either syncope or pseudo-apoplectic or convulsive attacks.
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.
The cause of an irregularly acting heart in an adult may be organic, as in the various forms of myocarditis, in broken compensation of valvular disease, Stokes-Adams disease, coronary disease, auricular fibrillation, auricular flutter, cerebral disease, and toxemias from various kinds of serious organic disease.
If the heart is slowed as a whole, the trouble might be due to diseased arteries or pressure from a growth, a gumma, perhaps, or other brain tumor in the region of the pons Varolii or medulla oblongata; or a hemorrhage into the fourth ventricle, causing pressure, could be the cause. The treatment of true Stokes-Adams disease is unsuccessful.
Endocarditis Acute, simple malignant Chronic Valvular Lesions Broken compensation Cardiac drugs Diet Resort treatment Cardiac disease in children Cardiac disease in pregnancy Coronary sclerosis Angina pectoris Pseudo-angina Stokes-Adams disease Arterial hypertension Cardiovascular-renal disease Arrhythmia Auricular fibrillation Bradycardia Paroxysmal tachycardia Hyperthyroidism Toxic disturbances Physiologic hypertrophies Simple dilatation Shock Stomach dilatation Anesthesia in heart disease
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