Sudden Heart Failure
( Originally Published 1921 )
It is necessary that the nurse should be instructed in the signs and treatment of sudden heart failure, because her help is often the only help available, and by the time the physician can be summoned the emergency has passed. The danger of sudden heart failure is the most important element in all accidents that are fatal a short time after the person has been injured. So the first variety of heart failure that is to be considered is that which happens from a shock to the system, whether the person has previously had heart disease or not. When the patient has had heart disease, of course, the danger is much greater.
Intense weakness of the heart accompanied by paralysis of the blood vessels, occurring after an operation or an accident, has received the name of shock, and is a condition that is especially considered and dreaded by those who have to do with surgical operations and accidents. A. patient suffering from sudden heart failure of this kind is often cold, almost pulse-less, has feeble heart action, and exhibits mental apathy, so that he does not seem to care what happens. It is a critical condition indeed and requires the most careful management.
When one is in this condition of heart weakness after an accident, he should be left perfectly quiet and not disturbed except for the most necessary attention to his injuries. If possible, he should not be removed from one place to another and should not be required to talk or make any exertion. Alcoholic stimulants should be given and the surface of the body warmed by external applications of heat. Those who have had most to do with heart weakness due to accident know that there is danger of doing too much for people in a condition of shock; they know also that the injudicious use of drugs is harmful, and that quiet, with the head low and feet raised, simple stimulants, and the application of heat constitute the most judicious management.
This whole condition is one of shock to the nervous system that has affected the circulation, and the natural reaction that follows, if the patient is to recover, is what is to be awaited.
Another variety of sudden heart failure is that which follows some strain of the heart in a person who has heart disease or a weak heart. Sometimes the signs are much like those of shock, but more often there is a sudden shortness of breath with pain around the heart, a marked throbbing of the blood vessels of the neck, and a visible beating of the heart itself. In this case direct treatment of the heart is important. The patient should be put to bed if the breathing is labored, supported in a sitting posture, the bowels moved by an active purge, and little food given for a time. The heart has been strained just as a wire spring is strained if it is stretched so far that it does not return to its original form or position. For the time being the heart has lost its tone, and until the tone can be restored, it must be relieved as much as possible from its work by absolute rest, low diet, and appropriate medical treatment.
In a sudden case, there is no objection to the use of whiskey and other alcoholic stimulants, and there are certain instances where the old fashioned treatment of bleeding might be advisable. If the condition is extremely serious, there will develop dropsy of the lung, leading to a cough, a rattling sound, and great shortness of breath. If this be the case, the management described elsewhere for oedema of the lungs must be used, namely, mustard, hot poultices, and cupping.
A third variety of heart failure that should be understood is the temporary failure of the heart from some emotional cause. This is seen in ordinary fainting when the heart does not supply blood to the brain on account of a great relaxation of the arteries, and consciousness is lost. Ordinarily, the vessels quickly resume their work, and no damage is done. The treatment for such failure is to put the patient with the head low so that the brain is supplied with blood. No other treatment is ordinarily necessary, tho something like smelling salts that will create a profound impression on the senses will bring the patient to consciousness more quickly.
All these forms of heart failure are liable to happen to persons previously healthy when there is sufficient cause ; but heart patients, of course, are much more liable to them.
There is another form of heart failure that is due to failure of the circulation of the blood in the heart muscle itself, caused by a stoppage of the arteries of the heart. The symptoms may resemble any of the three described, but it is much more dangerous than any of them.
Considering the number of people who have heart trouble, and the risks they constantly run, sudden death is not a common accident. It is safe to assure people with heart trouble that with proper supervision they are really less apt to suffer sudden heart failure than many of their acquaintances who are not aware of their danger. Almost any one can prove from his own experience or observation that those who constantly expect trouble from heart disease may keep well while friends and relatives who are considered healthy and strong suffer attacks.
The nurse should be supplied with a few simple remedies for use on her own initiative: these are nitroglycerin, strychnine, aromatic spirits of ammonia, and whiskey. Digitalis is too slow in action for emergencies, and should always be given under the direction of a medical adviser. During a heart attack the nurse should exclude all nervous and exciting people and as soon as possible get the patient composed and at rest, because the heart is affected by everything in the nature of excitement, and recovery may be prevented by the over anxiety and excitement of those who are present.
Sometimes a person suffering from bad breathing has much discomfort because he cannot assume what to him is the most satisfactory position. Many people in this situation require to lean forward, and to them the bedtable is a great comfort. Place the bed-table in the bed in front of the sufferer and cover with a pillow. It should be at such a height that the arms may rest comfortably upon it. By the bed-table we mean the table usually used in bed to serve meals to sick people. Heart tables, as shows in the illustration, are, of course, much better. They fit across the bed and can be adjusted to any height. Sometimes a head rest is provided with them.