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Updated: June 10, 2025
The treatment of this acute or gradual dilatation is absolute rest, with small doses of digitalis gradually but slowly increased, and when the proper dosage is decided on, administered at that dosage but once a day. Cardiac stimulants should not be given, except when faintness or syncope has occurred, and if strychnin is used, it should be in small closes.
The pupils were dilated, there were dimness of vision, confusion of thought, and extreme prostration. The pulse was scarcely apparent, the skin was white and wet with clammy perspiration. Happily, strychnin was given in time to effect recovery, and without early medical assistance she would undoubtedly have succumbed. There are several similar cases on record.
The dyspnea is sometimes very great, and cyanosis may be present, especially during paroxysms of coughing. This lesion of the heart is always benefited by digitalis, but the continuance of the improvement and its amount depend, of course, on the cause of the dilatation of the ventricle. Strychnin is often of advantage.
We have ceased to purge and bleed and sweat, and to give large doses of aconite or veratrum viride; have ceased to starve the patient too long; we have ceased to load him with alcohol to the point of circulatory prostration, and we have recognized that he must be braced from start to finish; strychnin is the drug which has been used for this purpose, and, as stated above, overused.
The patient should be nourished well, and there need be no restriction in the diet such as is required in gouty patients, so long as the digestion is not impaired. Benefit is also derived from the administration of cod-liver oil, and of tonics, such as strychnin, arsenic, and iron, and in some cases of iodide of potassium. Luff recommends the administration over long periods of guaiacol carbonate, in cachets beginning with doses of 5–10
If it increases the cardiac pain and distress, it should not be used. Strychnin is then the drug relied on, with such other general medication as is needed, combined with the coincident administration of nitroglycerin, which may also be given in conjunction with digitalis, if deemed advisable.
Gray speaks of a man who took 22 grains and was not seen for about an hour. He had vomited some of it immediately after taking the dose, and was successfully treated with chloral hydrate. A curious case is mentioned in which three mustard plasters, one on the throat, one on the back of the neck, and another on the left shoulder of a woman, produced symptoms similar to strychnin poisoning.
If such be the fact, strychnin is not acting for good in a patient who has cardiac weakness. Strychnin is a much overused drug. It is now given for almost everything and during almost every disease. It is true that the administration of strychnin is largely due to the evolution of the age in which we are now living.
Various drugs administered internally, such as quinine, salol, salicylate of iron, and others, have a reputation, more or less deserved, as internal antiseptics. Weakness of the heart, as indicated by the condition of the pulse, is treated by the use of such drugs as digitalis, strophanthus, or strychnin, according to circumstances.
Strychnin should be avoided, if possible, in the evening in order that the patient may sleep. Whether it should be given by the mouth or hypodermically would depend entirely on the seriousness of the condition. Once in six hours is generally often enough for strychnin to be administered unless the dose is very small. It is rarely, if ever, advisable to use alcohol.
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