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Sometimes the hypnotic selected, if one is needed, will be sufficient to quiet the cardiac aches or pains. If there is much restlessness and the circulation is good, that is, if myocarditis is probably not present, the bromids may be of great value, especially in children. The dose should be sufficient to quiet the nervous system.
Some very high tension cases, especially in women at the menopause, and where there is no kidney involvement, have the blood pressure reduced successfully only by large doses of thyroid, sometimes well combined with bromids, especially if the thyroid causes excitation. Such treatment persisted in for a time may cause months of improvement, and even years.
If the depressing action of bromids on the heart is counteracted by the coincident administration of digitalis, they will act only for good by quieting the nervous system and more or less inhibiting the secretion of the thyroid gland. If a patient has exophthalmic goiter fully developed, absolute rest in bed, with the treatment outlined above, should soon cause improvement.
Bromids, of course, will lower the blood pressure, but they depress all metabolism, interfere with digestion, and are not advisable for any length of time. However, in some cases they cause a marked improvement in the patient's condition. Patients under treatment with chloral, bromids, and thyroid especially, should be carefully watched and the treatment modified to meet the varying conditions.
If the heart is very weak, small closes of morphin may be used. If the heart is not weak, bromids or chloral may be given.
If the pulse is very weak, the cerebral sedatives more frequently used in delirium tremens, such as chloral, bromids, paraldehyd, etc., are generally contraindicated. A hot foot-bath and an ice-cap on the head sometimes aid in establishing a more general equalization of the circulation.
Atropin should not be given, as it may increase the cardiac disturbance. If an attack lasts more than an hour or so, one of the best treatments is the bromids, which should be given either by potassium or sodium bromid in a dose of 2 or 3 gm.
The treatment is simply to lower the diet, cause catharsis, give hot baths, stop the tobacco, tea and coffee, stop the drinking of large amounts of liquid at any one time, and administer bromids and perhaps nitroglycerin, when all the symptoms of simple hypertrophy will, temporarily at least, disappear.
Good general elimination by catharsis, warm baths to increase the peripheral circulation, a low diet for a few days, abstinence from any toxin which could cause this cardiac irritation, extra physical and mental rest, sometimes nervous sedatives such as bromids, and perhaps a lowering of the blood pressure by nitroglycerin, if such is indicated, or an increase of the cardiac tone by digitalis if that is indicated, will generally remove the cardiac irritation and prevent the extrasystoles, and the heart will again become regular.
If the circulation is good and the heart is strong, and yet these irregular pains and irregular contractions occur, the bromids act favorably and successfully. This is probably on account of their ability to quiet the central nervous system, to quiet and soothe the irritability of the heart, and to relax the peripheral blood vessels. The dose should be from 0.5 to 1 gm.
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