The impulse originates in the S-A node but the rate is less than 60 beats per minute. Sinus brady cardia may occur in health from predominance of vagal tone. It is commonly seen in athletes. These are usually no associated symptoms and the electrocardiogram is normal. It may occur pathologically, e.g. in convalescence from infective fevers, raised intracranial pressure, myxoedema, jaundice or excessive dosage with digitalis. The impulse originates in the S-A node but the rate is greater than 90 (adults) Sinus tachycardia may be associated with exercise or emotion or it may accompany fever, thyrotoxicosis, shock, acute haemorrhage, constrictive pericarditis or cardiac failure. The rate rarely exceeds 160 beats per minute and the electrodiogram is normal. The impulse orginates in the S-A node but the rhythm is irregular. The heart rate increases in inspiration and slows in expiration. Hence deep breathing may help in its differentiation from other arrhythmias. This rhythm is of no pathological signification and is most commonly seen in the young. The electrocardiogram shows rhythmic variations in the length of the cardiac cycler but is otherwise normal.
Benzathine penicillin has a much longer duration of action than procaine benzylpenicillin. A single injection of 600,000 units will maintain, for about one week, blood levels suitable for the treatment of chronic diseases such as syphilis or yaws, but which would be inadequate in the case of acute infections such as bronchopneumonia. Benzathine penicillin may be useful when the patient cannot be relied upon to report regularly for treatment.
Apart from their use in the special circumstances which have been mentioned, the long-acting penicillins given by injection have now largely been replaced by preparations such as phenoxy methylpenicillin which are effective when given by mouth. The choice of preparation usually rests between benzylpenicillin by injection for a serious infection and oral penicillin for the less acute process.
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