Attacks Of Marked Feebleness Or Heart Failure
( Originally Published 1921 )
Attacks of great feebleness of the heart are liable to excite unnecessary anxiety; because the rule is that hearts go to pieces in a struggle rather than by just lying down and petering out. In most instances a slowly and gently acting heart, even tho it does not cause 'a satisfactory pulse, is behaving in a conservative manner. All that is necessary in the treatment of such a condition is to leave people alone, and not call upon them for any undue exertion. If you can build up a person's general strength, the heart will respond; if you can not, nothing is gained by stimulating the heart. I have known great harm to be done by the attempt to create a satisfactory pulse at the wrist when the person ought to have been left alone.
Remember the three points of evidence of failure of the heart; if they are absent, do not worry about the feeble beat. These three points are: shortness of breath, tenderness over the region of the liver, and swelling of the feet.
In severe illness sudden or gradual heart failure should be guarded against, and the possibility of damage to the heart from inflammation which complicates so many infectious diseases must be considered. On account of the danger of sudden heart failure in severe illness, the patient should never be allowed to sit up suddenly or make any great exertion.
While the use of stimulants or stimulation in moderation is judicious even in prolonged illness, still the abuse of stimulants may, by using up the heart's strength and disturbing its natural adjustment, really increase the danger of sudden heart failure.
The danger of sudden heart failure is not indicated by a feeble heart action nearly so much as by a rapid one that is using up the heart's reserve force. Perhaps the worst blunder that is made by those who lack judgment is in applying stimulants to increase the force of the pulse wave when it is accomplishing the conservation of energy by a limited output of heart force. It is a frequent observation in hospital work that the patient with typhoid who has a feeble pulse outlives the one with the strong pulse.
A tendency to heart failure is to be discovered not by a measurement of the heart's action, but by the development of, the signs of dilatation and by the appearance of a disturbance of force and rhythm that indicates to the experienced observer a loss of tone of the heart muscle and a disturbance of its power of contraction.
n ordinary acute disease, it is much safer for those who are not physicians to treat people by careful nursing and leave heart stimulants alone, except in emergencies. There is no better indication of the integrity of the heart than the circulation in the lungs, and if a tendency of heart weakness is feared in a patient who is in bed, an examination of the back of the lungs by the physician, to determine the presence of moist sounds on deep inspiration, will settle the question at once.
The care of the heart in acute illness seldom calls for the use of stimulants. The presence of the disease stimulates the heart, and it is the use of remedies that quiet the heart, such as aconite, that is necessary.
It is the nurse's duty to keep a constant watch on the pulse and to call the doctor's attention to any increase in rapidity for the reason that a rapid pulse always is a sign of weakness.
In some diseases the outcome depends almost entirely upon the heart. This is true of pneumonia, and patients nearly always recover from pneumonia unless heart failure sets in. In this disease, the pulse may be deceptive for the reason that the pulse at the wrist is caused by the left side of the heart, while the right side of the heart must bear the burden of carrying on the circulation in the diseased lungs. So in pneumonia great blueness is a serious symptom, even tho the pulse may he good.
In typhoid fever it is important that the patient receive sufficient nourishment so that the heart may not become exhausted. A nurse should know that two quarts of milk a day is not enough food and that the patient should have a more varied diet. If the diet is exclusively milk, the patient should have at least three quarts. There is no objection in typhoid fever to the use of farinaceous gruel, strained broths of mutton, chicken, or beef, clam juice, farina, arrowroot, custard, egg-nog, and cream.
When a person rapidly loses weight in typhoid fever, attention should certainly be given to variation in diet, so as to raise its caloric value.
In general, in the treatment of emergencies, be guided in measure by the instincts of the person. The man who feels that he must sit by an open window should not be compelled to lie flat in bed in a close room. The person who knows how to stop his palpitation by some particular maneuver should be allowed to do it. The individuality of the person and his past experience will always be consulted by the wise attendant.
Under observation at the present time are a man and a girl, both of whom are liable to severe attacks of pain in the heart. These come on suddenly at night, and both of them get no relief until they get out of bed and stand upright. Any one who forbade these people from relieving their agony in this way would be short-sighted. The person who has lived years with a disease, even tho it is his own, knows more about it than even the physician who is not acquainted with the case, and the sufferer's experience is too valuable not to be regarded.