| Abstract: | Dr. Gold: The treatment of disorders of cardiac rhythm was explored in this conference. This was a very large undertaking. There are several types of disorders of rhythm; there are various devices for distinguishing one from another. It is important to do so for there are significant differences in the treatment of each, and the most successful results depend on the use of measures specifically suited to the particular problem. A special conference could be profitably devoted to any one disorder of rhythm.There has been no attempt to exhaust the subject, but many points of practical interest have been brought out in the account of experience and opinion by the various participants. Many of the details cannot be satisfactorily summarized without repeating the conference. The following disorders of rhythm received attention: premature contractions, auricular and nodal tachycardia, auricular flutter, auricular fibrillation, ventricular tachycardia and heart block. There was some discussion of the management of congestive failure in the course of a paroxysm of abnormal rhythm and the problem of ectopic rhythms occurring in the hyperthyroid state. It was pointed out that three distinct problems prevail in cases of disordered rhythm, namely, those in whom the disordered rhythm is a chronic phenomenon and is to be allowed to continue, those in whom an acute paroxysm needs to be terminated and those in whom the problem is essentially one of preventing recurrences. Means for differential diagnosis were described, namely, certain clinical features, the electrocardiogram, carotid sinus pressure and various devices exerting similar effects.The application of several drugs was discussed in some detail, such as quinidine, digitalis, magnesium sulfate, procaine, mecholyl, ipecac, ephedrine, morphine and other sedatives. In a patient with a paroxysm of rapid heart action which does not appear to be damaging the circulation unduly, there are some who prefer to give a dose of morphine to make the patient more comfortable and let the problem rest until the abnormal rhythm ceases spontaneously. Digitalis appears to be the drug of choice for the paroxysm of auricular and nodal tachycardia. While mecholyl is very effective, it is so apt to produce disturbing symptoms that it is best to keep it in reserve for use when other measures fail. Quinidine is the standard remedy for an attack of ventricular tachycardia; and when for one reason or another it proves inadequate, an intravenous injection of magnesium sulfate is sometimes effective. There are risks involved in the use of all these drugs to abolish a paroxysm of abnormal rhythm, and technics were described for reducing the hazards to a minimum.Attention was called to the fact that there are many situations in which a differential diagnosis among the disorders of rhythm is difficult or impossible to make, but that even under those conditions, a specific form of therapy is still available; for quinidine is highly effective against five of the more common disorders of rhythm: premature contractions, paroxysmal auricular tachycardia, auricular flutter, auricular fibrillation and ventricular tachycardia. Strong emphasis was placed, however, on the desirability for making every effort to establish the precise mechanism before treatment is started, for only then is the most rational and effective plan of therapy possible.Finally, the point was made that one should always bear in mind the underlying state of the heart in which a rapid ectopic rhythm has suddenly appeared. The abnormal rhythm is a dramatic event and may engage the attention of the examiner to the exclusion of other factors of far greater importance than the abnormal rhythm, such as Graves' disease or an acute coronary thrombosis. |
