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Updated: May 8, 2025
Taking out a stethoscope, Donald bade the giant open his soft, homemade shirt, and planted the transmitting disk against the massive chest, padded with wonderful, bulging muscles. "O-ho," he said under his breath, as he finally laid the instrument aside; for his intently listening ears had caught the faint, but clearly discernible sound of a systolic murmur, deep within.
Neurasthenic patients quite generally have hypotension, although occasionally with suprarenal disturbance they may have an increased tension. Jour. A systolic pressure of 110 mm. or lower in an adult should be considered hypotension, anything below 105 mm. calls for treatment, and a systolic pressure of 100 or lower in an adult calls for rest from all active duties.
The characteristic murmur of this lesion is a systolic blow, accentuated at the apex, transmitted to the left of the thorax, generally heard in the back, near the lower end of the scapula, and transmitted upward over the precordia. Of all cardiac lesions, this is the safest one to have.
A rising blood pressure in pregnancy, when associated with other toxic symptoms, is indicative of danger, and Evans believes that a systolic pressure of 160 mm, is ordinarily the danger limit. When the systolic pressure is above 130, the patient should be carefully watched, and he thinks that 150 is the danger line.
Nature causes these hearts, when they are disturbed or excited, to pulsate slowly, causing the diastole to be longer than in a heart with mitral regurgitation. This allows more blood to enter the left ventricle, and the left ventricle, acting perfectly on the blood which it receives, causes a good systolic pressure in the aorta and the systemic arteries.
If there is increased venous congestion and increased venous pressure and a high diastolic pressure with a low systolic pressure, digitalis not only will often raise the systolic pressure, but also will lower diastolic by improving the general circulation and removing venous congestion.
This hypertension is generally improved under proper treatment. He found that in seriously ill patients this high diastolic pressure is of bad prognosis. He also found that a lower systolic pressure with a lower diastolic pressure is not a sign that the heart is weakening, but only that the visceral tone is growing less.
He gives it hypodermically, 15 minims at the first dose and 5 minims subsequently, until the systolic pressure is reduced to 140 or less. He admits that this is rather strenuous treatment. He does not speak of treatment by thyroid extracts, which has been regarded as valuable by some other workers. In these patients who show eclamptic symptoms, he maintains a milk diet, and purging and sweating.
On the other hand, it is now generally proved that persons with overweight have a systolic pressure greater than is normal for individuals of the same age. He believes that diastolic pressure may range anywhere from 60 mm. of mercury to 105, and the person still be normal.
This is not to state that every high tension must be lowered, but every hypertension must be studied and a safer systolic pressure caused if it is possible without interfering with the person's efficiency. A high diastolic pressure, one above 105, certainly must receive immediate attention, and a diastolic pressure of 110 must be lowered, if possible.
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