Gradual Cardiac Failure with Tendency to Dilation.
In these cases the heart is just gradually giving out, beginning to dilate a little becoming slightly irregular while the patients are going down hill. If the condition is not so acute as to call for one of the four drugs we have been discussing there are another three or four which you may find very helpful. That is quite apart from your ordinary prescribing. You find that in many of these cases in which there is a tendency to cardiac failure the heart picks up and the tendency to dilation disappears on your ordinary prescribing and you do not need to prescribe on the cardiac symptoms particularly that is to say, the patient responds to the drug for their general symptoms. For instance quite frequently in pneumonia a bad case, with the patient pretty worn out with indications for Lycopodium there is a tendency to a failing heart, with dilations for Lycopodium there is a tendency to failing heart with dilatation but after the administration of Lycopodium the heart picks up, the pulse steadies and the tendency to dilatation disappears. You find the same in all acute illness where the patient is responding to the particular drug indicated. But you also get cases in which the patient is doing quite well but there is a tendency to cardiac failure which is not responding to the apparently indicated remedy, then you have to consider the drugs for cardiac failure in addition.
For the cases the most common drugs are the the snake poisons especially Lachesis and Naja. And less commonly Lycopus and Laurocerasus.
It is very difficult to distinguish one snake poison from another in such condition. In appearance they are all very similar but much the most common remedies for these conditions are Lachesis and Naja.
The Lachesis picture I think is pretty typical of all, and there are just a few indications which make one choose Naja in preference to Lachesis.
In all these cases indicating the snake poison you get a rather purplish bloated appearance. They suffer from a feeling of tightness or constriction in the chest, more commonly feeling of tightness or constriction in the chest, more commonly in the upper part of the chest and they are intolerant of any weight or pressure of the bedclothes, or any tight clothing to heat they feel hot and they dislike a hot stuffy room. They have a marked aggravation after sleep; they get acute suffocative attacks when they fall asleep and they wake up in increased distress.
All these snake poison patients in their cardiac distresses have a marked aggravation from being turned over on to the left side. They have a very marked tremor, and their hands are shaky. And most of them as they tend to get worse become mentally fogged, confused and very often become difficult and suspicious.
If there was nothing more than that one would give Lachesis. But in a certain number of these cases you get rather acute stitching pains which go right through the chest from the precordium to the region of the scapula, associated with very marked numbness particularly in the left arm and hand. Where the numbness particularly in the left arm and hand. Where the numbness is pronounced one would give Naja in preference to Lachesis.
If the pain – Stitching in character – is more marked one tends to give Naja but if the feeling of constriction is predominant then Lachesis is the remedy. But the general symptoms are identical.
I think possibly Naja is a little less red, less bloated looking a little paler than Lachesis but that is not very striking.
Apart from the snake poisons there are two other drugs which you will find very useful in these conditions. The first of these is Lycopus.
You get indication for Lycopus in a case in which the heart is just starting to fail; it is beginning to dilate a little and the pulse is tending to become a little irregular.
The patients are pale rather than cyanotic and are always.
The outstanding symptoms of the Lycopus case is that the patients complain of a horrible tumultuous sensation in the cardiac region. They very often tell you it feels as if their heart had suddenly run away and was just going mad. This is accompanied by a feeling of intense throbbing extending up into the neck and right into the head.
The other Lycopus symptom which helps is that accompanying this tumult in the chest there is a very marked tendency to cough. It feels as if the heart just runs away it sets up acute irritation and they cough.
Another Lycopus distinguishing symptom is that the distress is vastly increased by turning over on the right side a contrast with the snake poisons which are worse turning over on the left side.
Lastly these Lycopus patients have an intense dislike of any food and particularly of the smell of food.
The last of these drugs I want to touch on is Laurocerasus.
The Laurocerasus picture is very definite, and I think the easiest way to remember it is to picture for yourself the appearance presented by a congenital heart in a patients 16 to 18 years of age. You know the peculiar bluish red appearance of the congenital heart, somewhat clubbed fingers, which again are rather congested and the bluish appearance almost like ripe grapes of the lips. That is the under lying colour you get in Laurocerasus.
These patients always suffer from extreme dyspnoea, very nearly Cheyne-Stokes in character. They take a sudden gasp for breath, followed by two or three long breaths, then the breathing gets gradually shallower, next a pause, then two or three gasps and so it goes on.
Another features is that the respiratory dyspnoea gets very much worse when the patient sits up; they are better in a semi- prone position.
A point which is an apparent contradiction is that with this extreme cyanosis you get a very early tendency to the development of hypostatic pneumonia at the bases, and when it has developed the cough is very much more troublesome unless they are reasonably propped up. When lying down unless they are reasonably propped up. When lying down the cough is worse, yet if they sit up the feeling of constriction the cough is worse yet if they sit up the feeling of constriction is increased so they have to get a position midway between.
The patients are always chilly. They want to be kept warm, and they feel cold to touch And of course, as you would expect in a condition of that sort, any movement or exertion aggravates them acutely.