Endocarditis and pericarditis in the course of rheumatism; acute fevers like typhoid, etc.
Pericarditis is a rare complication, and is apt to coexist with pleuro-pneumonia.
The following case, showing the liability to pericarditis and other serous inflammation which exists in scarlet fever, occurred in my practice: Case 6.
Pericarditis is less frequent, and occurs usually without symptoms toward the close of life.
The same may be said of the endocarditis and pericarditis noted by several authors.
Pericarditis is occasionally present, and is marked by the usual lesions.
Rheumatism has never in my practice been dangerous, nor has it materially retarded convalescence, except when it affected the heart, causing pericarditisor endocarditis, when it involves great danger.
Endocarditis and pericarditis require rest in the horizontal position, avoidance of all excitement, the use of the tincture or infusion of digitalis or of the fluid extract of convalaria to procure a slow and steady action of the heart.
Of the serous inflammations occurring in scarlet fever, pericarditis has been, according to Rilliet and Barthez, most frequently observed.
Scurvy, and conditions of the blood analogous to those produced by that disease, make it almost certain that if pleurisy or pericarditis occurs while these conditions exist, it will be hemorrhagic.
When it does occur, pain is experienced about the heart; the action of the organ becomes irregular; praecordial anxiety and oppression are felt; suffocative attacks occur; and very soon the symptoms of pericarditis arise.
Having once hesitated to aspirate in recent rheumatic pericarditis with copious effusion in a lad, and found a large amount of pus in the sac after death, I would warn against hesitancy under such circumstances.
Pericarditis occurs in those cases in which discharge takes place in this direction, and it may develop, as does pleuritis, in advance of any change in the diaphragm.
Sibson asserts that if in rheumatic pericarditis "pain over the heart is increased or excited by pressure over the region of the organ, it may with an approach to certainty be attributed to inflammation of the pleura," etc.
In pericarditis limited to that portion of the membrane which covers the great vessels no friction murmur may be audible, or it may be heard and be with difficulty distinguished from an endocardial murmur.
Cattle may suffer from traumatic pericarditis caused by sharp, pointed, foreign bodies passing through the wall of the reticulum and penetrating the pericardial sack.
If the heart becomes injured, symptoms of pericarditis are manifested.
The symptoms of pericarditis may not be recognized at the very beginning when the disease occurs as a complication of influenza, or infectious pleuropneumonia.
As stated above, if pericarditisdevelops during the progress of chronic disease, such as interstitial nephritis, or during sepsis, or from abscesses or growths in the region of the pericardium, the prognosis is bad.
True angina pectoris probably does not occur without some serious organic disease of the heart, mostly coronary sclerosis, fatty degeneration of the heart muscle, adherent pericarditis and perhaps some nerve degenerations.
The cause of pericarditis being so varied, any anti-toxin treatment or any vaccine treatment could be indicated only if the cause of the inflammation rendered the serum or vaccine advisable.
In pericarditis it is perhaps well always to administer an alkali in some form unless otherwise contraindicated, whether or not the cause is rheumatism.
It is a question as to when patients convalescent from pericarditis should be permitted exercise.
In dry pericarditis with serious adhesions, or if adhesions occur as a sequence of acute pericarditis, the future prognosis is bad, as myocarditis may develop and sudden death or acute dilatation may occur.
If the sickness preceding the pericarditis was not a long fever, and the heart muscle is considered in good condition, digitalis in small doses may be the best possible diuretic.
When pericarditis develops as a result of or in connection with pleuritis, the distinction may not be very clearly definable, neither will many recover.
Pericarditis may be induced by cold and damp stabling, exposure and fatigue, from wounds caused by broken ribs, etc.
It may be distinguished from pericarditis by the absence of the friction sounds and want of an enlarged area of dullness on percussion.
In acute or subacute pericarditis the tincture of digitalis may be given in 20 to 30 drop doses every hour until the pulse and temperature become reduced.
Pericarditis may at all times be regarded as a very serious affection.
Pericarditis scorbutica--a condition which has been observed mostly in Russia in recent times.
In some cases acute pericarditis is very distressing, in others it is mild.
After death frompericarditis there is always more or less fluid found in the pericardium; the surfaces are rough and covered with a yellow-colored exudate.
Inflammation of the muscular structure of the heart occurs in limited, circumscribed areas, as evidenced by post-mortem examination, and it is probably always somewhat involved in connection with pericarditis and endocarditis.
Care must be taken to differentiate pleurisy from traumatic pericarditis (which see).
When pericarditis is complicated with rheumatism or other diseases the latter must be treated as directed in the description of them.
Another diagnostic symptom of value is that in traumatic pericarditis respiration is painful, not difficult, and the respiratory rate is very much increased on movement.
Nonrhythmical heart sound is often caused by pericarditis or by disease of the valves.
Well, it appears to be pericarditis supervening on renal disease.
