Acute Inflammation of the Heart Case. Pericarditis.
THE pericardium, or heart case, is a membranous sac, in which the heart is contained. It is composed of two layers. The outside one is fibrous, dense and white; the inside one is serous. The serous layer forms the lining of the fibrous one, and then is reflected over the heart and the roots of the large blood vessels.
When the pericardium becomes acutely inflamed, it throws out both lymph and serum or water. The lymph often causes the two layers of the sac to grow together.
Physical Signs. The impulse is strong when the effusion of water is small, feeble and unequal when it is large. Percussion yields a dull sound in proportion to the amount of fluid in the sac.
When listening, with the stethoscope, a rough noise is heard, resembling either the rasping of wood, the grating of a nutmeg, the rustling of silk, or the crackling of parchment. Sometimes it is softer, like the blowing of a pair of bellows. Occasionally it resembles the creaking of a new shoe sole, or has a low creaking, like the tearing of linen cloth.
When there is effusion, the ordinary beats of the heart sound dull and distant.
General Symptoms. Acute inflammatory fever, generally preceded by chills, with pungent pain in the region of the heart, shooting to the left shoulder blade, shoulder, and upper arm.
Pain increased by taking a full breath, by stretching the left side, by percussion, and by pressure between the ribs over the heart. Sometimes the pain is in the epigastrium, or left hypochondrium. Inability to lie on the left side.
Explanation. The noises mentioned above are produced by the rubbing together of opposite surfaces of the heart case, made rough by the exudation of lymph. The rasping is supposed to be caused by firm and rugged lymph; the rustling and creaking, by soft and wet lymph; the bellows murmur, by soft and dry lymph; the creaking, croaking, and crackling, by dry, tough lymph. These sounds may all be imitated by rubbing a damp finger upon the back of the hand while listening with the stethoscope applied to the palm.
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