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Pericarditis - Rheumatism

inflammation, heart and symptoms


Between the pericardium of the Anatomist and that of the Pathol ogist there is no difference. Rheumatic pericarditis consists in rheu matic inflammation of the investing membrane of the heart. As already explained, such inflammation is most common in acute cases and in young subjects.

Of all the serous membranes of the body the pericardium is the only one which invests an organ having free and active movements. So far as functional activity is concerned the pericardium is as much above other serous membranes, as the valves of the left side of the heart are above those of the right, and the fibrous tissues and serous linings of the large joints above those of the small. In its liability to rheumatic inflammation the pericardium is in the same position as the lining membrane of a large joint.

Pericarditis occurs in different degrees of severity. The whole membrane may be the seat of acute inflammation ; or only a small part of it may be affected. According to its extent and severity ate the symptoms to which it gives rise. As a rule, subjective symptoms are more marked than in endocarditis. In acute and severe cases pain in the region of the heart is generally present at the outset, and is of ten the first thing complained of. Usually it is increased by

pressure over the heart, or in the epigastrium. The patient is rest less and distressed; his countenance has an anxious expression; the breathing is quickened; there is generally a short, frequent cough; the heart's action is vigorous and rapid—may be tumultuous, vio lent, and irregular. On auscultation there is heard the friction sound produced by the rubbing against each other of the roughened peri cardial surfaces.

But the heart symptoms are not always so distinct in these acute cases. Occasionally their place is taken by nervous symptoms so marked that the case is apt to be mistaken for one of cerebral rheu matism. The onset of the pericardial inflammation may be ushered in by delirium; and delirium, stupor, and coma may remain the characteristic symptoms throughout. From beginning to end there may not be a single subjective symptom of cardiac disturbance.

The following case, recorded by Andral, is a good illustration of the manner in which acute pericarditis may simulate inflammatory mischief in the nervous centres :