R. H. McDONALD, M.D.
Division of Internal Medicine
A. C. CORCORAN, M.D.
FAY LeFEVRE, M.D.
Section on Cardiovascular Disease
The treatment of edema is at first directed toward correction of the causal mechanisms. These were reviewed in the first paper of this series, the clinical states in which they act discussed in the second. Since in many diseases more than one mechanism operates in causing edema, the treatment of different types overlaps. Some of the abnormal mechanisms are not wholly reversible. In such cases treatment is aimed toward symptomatic relief rather than radical cure.
Cardiac edema, the most important, is also the most common and easily treated form; it is that which occurs in chronic congestive cardiac failure. The principles underlying its treatment are: (1) rest, (2) digitalization, (3) restriction of sodium salts, (4) diuresis by drugs, and (5) diuresis by water. These principles apply to forms other than cardiac edema. Their application is, therefore, discussed in detail under the present heading only.
By complete bed rest is usually meant that the patient at all times must lie quietly in bed. While bed rest is essential, in cardiac failure the rule is relaxed to greater or less degree. Adherence to complete bed rest may be quite as dangerous as the effort it seeks to avoid.
Thus the patient with congestive cardiac failure is nearly always more comfortable in the sitting or semi-sitting position than in the supine posture and will naturally assume this position. Imposition of a recumbent posture in the presence of massive cardiac edema may increase discomfort by translocating fluid from the. . .