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Other drugs are considered in the discussion of hypertension. If the heart actually fails, the treatment becomes that of chronic myocarditis and of dilatation. Not infrequently in sclerosis of the arteries, especially of the coronary arteries, the blood pressure is not high, but low, and the heart is insufficient.
Injuries of various kinds are inflicted upon the coronary region but usually they are due to the foot being trampled upon. When the foot that inflicts the injury happens to be unshod, a contusion of the injured member is occasioned, but in the majority of instances, wounds that demand attention are the result of shoe calks which have penetrated the tissues in the region of the coronary band.
The compression of a tight bandage around the abdomen, or the infusion of blood or saline solutions, especially when combined with minute amounts of epinephrin, will raise the blood pressure and increase the coronary circulation and therefore the nutrition of the heart. He also finds that the effect of height on blood pressure in adults seems to be negligible.
A patient with coronary disease should certainly not go to any great altitude, while patients with compensated valvular lesions, he found, were not injured by ordinary heights. He found that altitude seemed to decrease high systolic and diastolic pressures, while it even elevated those which were below normal, and caused these patients to feel better.
While this disease almost invariably has a pathology, cases have occurred in which no lesion of the heart could be found, but it generally occurs coincidently with arteriosclerosis, in which the coronary arteries are more or less involved and the arterial system of the brain may be diseased. It occurs more frequently in men than in women, and in them mostly after middle, or in advanced, life.
He selected the ablest and most popular men in the city to be his favorite ministers Maecenas and Agrippa. His policy was peace. He declined the coronary gold proffered by the Italian states.
These general taxes were imposed and levied by the absolute authority of the monarch; but the occasional offerings of the coronary goldstill retained the name and semblance of popular consent.
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.
The stimulus must regularly begin in the auricle, must be perfectly transmitted through the bundle of His to the ventricles, the ventricles must normally contract with the normal and regular force, the valves must close normally and at the proper time, the blood pressure in the aorta must be normally constant to insure the perfect transmission of the blood to the peripheral arteries and to insure the normal circulation through the coronary arteries, and the arterioles must be normally elastic.
White found that about half of his cases of pulsus alternans showed an increased blood pressure of 160 mm. or more; 62 percent. were in patients over 50 years of age, and 69 percent. were in men. Necropsics on patients who died of this condition showed coronary sclerosis and arteriosclerotic kidneys.
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