Water in the Heart Case. Hydro pericardium.
This disease is common as an attendant of general dropsy.
Physical Signs. The impulse is undulatory, as if transmitted through a fluid, and it is not always of the same strength
The dullness extends upward in a conical form, in proportion to the amount of fluid, sometimes rising as high as the second rib. The impulse does not coincide with the first beat of the heart.
General Symptoms. The patient has a sensation of the heart being in a floating state. The pulse is small, frequent, and intermittent.
Explanation. The reason that the impulse does not occur at the same time with the first beat of the heart is, that the apex does not immediately strike the walls of the chest, sometimes being required to push it up through the fluid.
The beats of the heart sound more distant than natural in consequence of the organ being pushed away from the walls of the chest by the fluid and the impulse will be noticed in the usual place namely, inside the nipple line between the fifth and sixth rib spaces, but the intensity of the sound will be lessened. The position is in a different place; in dilatation of the heart, when the impulse more or less faint will be noticed far to the left of the nipple line.
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