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When the inflammation occurs as a complication of acute rheumatism, it has been suggested that salicylates, which arc not inhibiting rheumatism and may be depressant to the heart, should be stopped if they are being administered; but if the salicylates are apparently improving the inflammation in the joints, pericarditis would not contraindicate their continued use.
On the following day there was pain in the epigastrium, and by the fourth day the pain extended to the vertebrae, with vomiting, delirium, and death on the fifth day. At the autopsy it was found that a foreign body, seven cm. long had perforated the pericardium, causing a suppurative pericarditis.
If the myocardium is much inflamed at the same time, the heart becomes more rapid and the blood tension lowered, and the apex beat diminished in intensity and perhaps not palpable. If there is pain, with or without pericarditis, it is often referred to the epigastrium, especially in children. The patient is often nervous, restless and sleepless. In simple endocarditis emboli rarely occur.
Various explanations of the heart pang have been suggested, such as a spasm or cramp of the heart muscle, sudden interference with the heart's action, as adherent pericarditis, a sudden dilatation of the heart, an interference with the usual stimuli from auricle to ventricle and therefore a very irregular contraction, a sudden obstruction to the blood flow through a coronary artery, or a sudden spasm from irritation associated with some of the intercostal or more external chest muscles causing besides the pang a sense of constriction.
Following dry pericarditis or pericarditis with an exudate, especially when the exudate is fibrinous in character, the fibrous substance which is not absorbed or resorbed may develop into connective tissue, and the two pericardial surfaces become permanently grown together, causing the so-called adherent pericarditis.
The general symptoms are pain, fever, weakness and marked emaciation. It is very difficult to form a correct diagnosis, as the disease comes on without any apparent cause. Sometimes a swelling is noticed in the right and inferior abdominal region. If the heart becomes injured, symptoms of pericarditis are manifested. The treatment is largely preventive.
As stated above, if pericarditis develops 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. In acute pericarditis, absolute mental as well as physical rest is essential.
For this reason, during severe illness, and especially in those diseases which are known to have pericarditis often as a sequence, frequent examination of the heart should be made as a routine procedure. If there is pain or much aching in the cardiac region, it tends to disappear with the exudate, if such is to occur, in the same way as does the pain of pleurisy.
The patient died one month after of another cause, and at the postmortem examination the aorta was shown to have been opened; the wound in its walls was covered with a spheric, indurated coagulum. No attempt at union had been made. Zillner observed a penetrating wound of the aorta after which the patient lived sixteen days, finally dying of pericarditis.
The blood must be kept strongly alkaline. It is possible that one of the reasons why pericarditis or endocarditis occurs so frequently in serious prolonged fevers is that the patient has not eaten enough cereals or other carbohydrates, and the system has become more or less endangered by acidosis.
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