PER'ICARDI'TIS (Neo-Lat., from perirar dium, from ) k. Irepecdp5.orr, prrikardion, mem brane around the heart. new sg. of rEpocdpatos, perikardios, surrounding the heart. from crept, pert, around Kapola, kardia, heart: eonneeted with Lat. eon, Lith. szird is, OChureh Slay. sridicr, Guth. hairto, 011G. bgigef. I:er. firrz, _1 S. hcorte, Eng. heart, and probably with Skt. hrdage, Av. r.Jrnlaya, heart, or with Skt. sraddhei, Lat. ere dere, to trust). An intlamnmtion of the mem branous sac investing the heart—the pericardium.
membrane is composed of two layers, a serous one closely attached to the substance of the heart and a fibrous layer loosely enveloping the whole. The surfaces of these two layers are normally in contact and secrete a thin serous fluid which acts as a lubricant and prevents irri tation from the eon-tant movement of the sur faces upon each other. The intervening space. which exists only in pathological conditions. is called the perieardial cavity. In common with all serous membranes (q.v.). the pericardium is subject to two varieties of inflammation—the dry or plastic form and that characterized by effusion of fluid. In the dry variety, which is most common and least dangerous. there is first a dulling of the surfaces involved, due to a fibrinous exudation: constant rubbing roughens these librin-coated surfaces; the plastic, sticky material is thrown into ridges or drawn out into shreds. and presents a curiously shaggy appear ance—the so-called cog rillosum or hairy heart of the older writers. This form of pericarditis may terminate by absorption of the fluid, always leaving, however, an adhesion between the two layers; or the process may go on to the 'moist' form—pericarditis 'with effusion. Here an extra vasation of fluid occurs into the pericardial cavity amounting from a few drams to two quarts. This fluid is at first sern-fibrinous or hemorrhagic, but in some cases becomes rapidly purulent. When the amount of fluid is con siderable the heart's action is mechanically inter fered with, and death Amy take place from this cause in a few days.
Pericarditis may arise from many causes. The primary form, unassociated with any other dis ease, is comparatively rare, and occurs only in children. As a secondary process, it is a common affection. Rheumatism is responsible for more than 50 per cent. of the cases; septic processes in other parts of the body are frequent causes; tuber culosis, gout. Bright's disease, scurvy, diabetes,
and the eruptive fevers such as scarlatina and typhoid may he complicated by it; and, lastly, it may take place by extension front neighboring structures, as in pleuropneumonia or septic endo carditis, or it may result from a wound.
The symptoms of pericarditis are pain in the situation of the heart, increased by a full inspira tion, by pressure upon or between the ribs in the cardiac region, and especially by pressure up ward against the diaphragm by thrusting the fingers beneath the cartilages of the false ribs; palpitations; a dry cough and hurried respira tion; discomfort or pain on lying on the left side; restlessness; great anxiety of countenanee; and sometimes delirium. The pulse usually beats from 110 to 120 in a minute, and is sometimes intermittent ; and febrile symptoms are always present. Pericarditis is a disease which occa sionally runs a very rapid course. and terminates fatally in forty-eight hours or less. In ordinary cases. however, which terminate in apparent re covery, the disease generally begins to yield in a week nr ten clays, and excepting that adhesion remains, the cure appears to be complete in three weeks or less. But although these patients ap parently recover, the perieardial adhesion com monly occasions other structural changes of the heart sooner or later to develop themselves, and in those eases that the physician has the oppor tunity of subsequently watching, it is observed that fatal disease of the heart, primarily due to the pericarditis, almost always supervenes.
In this disease the patient must be kept abso lutely quiet. so as to throw as little work upon the heart as possible. The diet should be light, dry. and nutritious. In the early stages and in robust people, leeches may he applied over the perieardial area, or ice bags may be used to limit effusion. When effusion has taken place a blister will sometimes cause it to be absorbed. In suitable eases diuretics may be given to pro mote the action of the kidneys• and mild purga tion will be of service. When the effusion is so extensive as seriously to embarrass the heart's action it may be drawn off by paracentcsis. If the tluid be purulent, however, an incision must be made into the sac, through the chest wall, and the cavity drained.