The veins in the neck sometimes ex hibit a diastolic collapse, being at other times overfull. Much value is placed upon the diastolic shock, or rebound, which may be felt on placing the hand over the heart's apex.
Other points are the wide extent of the cardiac dullness and of visible cardiac motion, and the fixity of the apex-beat without regard to alteration of posture or respiratory influences.
The discovery of this condition is valu able only as a means of prognosis, the treatment being nil. The embarrassed heart may be stopped in a sudden fatal syncope, or go through the more grad ual changes of ruptured compensation. Sometimes chronic mer1instinitic pvtpurl through the diaphragm, in children, and gives rise to perihepatitis, perisplenitis, and chronic ascites.
Physical sign of adherent pericardium observed in four cases. In three eases there was abundant evidence of adhesion of the pericardium to the chest-wall as well as to the diaphragm, but in one the heart moved freely under the ribs and the lung expanded well over it. The sign consisted in a visible retraction, synchronous with the cardiac systole, of the left side of the back in the region of the eleventh and twelfth ribs. In three of the cases there was also systolic retraction of less degree in the same re gion on the right side. In all the cases there a definite history of pericardi tis. The only means of causing this re traction on both sides would seem to be the diaphragm, which, if pulled upon, would have more effect on the floating eleventh and twelfth ribs than on the other, more fixed, ones. Walter Broad bent (Lancet, July 27,'95).
Pericarditis in youth, before puberty, is often adhesive, and at no distant time proves fatal in association with great enlargement of the heart. Occurring later in life, adhesive pericarditis is un important. In children it is generally of rheumatic origin. Dickenson (Amer. Jour. Med. Sci., Dec., '96).
From study of a case of oblitera tive pericarditis causing hepatic enlarge ment and ascites, fallowing conclusions are offered: 1. Some cases of hepatic en largement with ascites, and other evi dence of portal stasis, appear to be due to chronic obliterative pericarditis. 2.
Appreciation of this possibility may lead to the correct diagnosis through careful and frequent examinations of the heart and close scouting of the previous his tory. 3. The disease appears to be rela tively frequent in persons under 30 years of age, and usually runs a course of from 6 to 12 years; that is, a longer course than most cases of primary alco holic cirrhosis. The fact is of impor tance in prognosis. 4. Treatment is in any case simply palliative. R. C. Cabot (Boston Med. and Surg. Jour., May 19, '9S).
Hydropericardium.—In dropsy of the pericardial sac it is usual to find post mortem a teaspoonful or two of serous fluid in the pericardium which probably transudes after death. Larger quantities may form during life as a result of chronic heart disease, emphysema, and more often chronic nephritis. In these cases there is no friction-sound nor other evidence of inflammatory change. The symptoms are usually merely those of the causative condition, although, of course, a large amount of fluid may add to the embarrassment of the heart.
The prognosis and treatment are di rected to the underlying disease, and it is rarely necessary to aspirate.
limmopericardium.—Blood in the peri cardial sac is a rare condition which may be caused by aneurism of the aorta, aneu rism of the coronary arteries, and by trauma. Death is usually too prompt for any treatment, and diagnosis is rarely possible. In a few traumatic cases aspira tion has been successfully carried out.
Pneumopericardium.—Air in the peri cardial sac may be caused by perforating glands, and by the perforation of some lesion in the lungs, oesophagus, or stom ach.
There is almost always a purulent ex udation in addition to the gas present; rarely there may be merely a sero-fibri nous fluid.
The auscultatory signs of such a con dition are striking; the sounds take on a metallic character, and there may be a splashing audible even at a distance. The areas of tympany and of dullness, re spectively, will be changed by altering the patient's posture. Treatment is the same as for a severe attack of ordinary pericarditis. The prognosis is extremely grave.