In chronic inflammation of the heart envelope a number of conditions, may finally appear which result in adhesion; and there have been found adhesions upon post-mortem examination, which were not suspected, and where there were no evidences of the heart disease during life. There is a variety of circumstances under which adhesion may occur, as well as variety of manifestations. There may be more or less complete adhesion between the parietal and visceral layers of the pericardium, resulting in the enclosure of the heart in a complete capsule. Or there may be one or more small adhesions between these two layers, or adhesion of small patches of the membrane. Or in case of an extension of an inflammation from the pleura to the pericardium there may be adhesions between the heart and the chest wall. Another form involves adhesion of the two layers to each other and to all contiguous tissues, forming an adhesive mass of the heart and its envelopes.
Symptomatology:—As stated, there may be adhesions in mild cases without sufficient evidences to positively declare them. The symptoms in more pronounced cases are not always sufficiently clear to enable a positive diagnosis or differential diagnosis to be made. There is always shortness of breath and pain, but the pain varies; it may be steady and constant, and not necessarily severe, or it may occur in paroxysms, usually after unusual effort, or after mental excitement, or a fit of anger. It may be mistaken in a severe paroxysm for angina pectoris. The pulse is rapid and feeble and tension and pressure are greatly reduced, or it may be irregular, and palpitation is of frequent occurrence. As a result of adhesion, the ventricles become dilated and hypertrophy with its concomitant symptoms— dropsy, prostration, vertigo and venous stasis—are all present.
Treatment:—The general condition of the patient should have the most careful and continuous oversight. Life can be greatly prolonged and made pleasant by this care and attention. Effusion should be retarded and its absorption and removal should be promoted by rational measures. When indications for treatment arise, which can be met specifically, they must at once receive prompt attention. Cactus will regulate the action of the heart and greatly improve its tone. Bryonia will allay irritability and relieve much of the pain and distress in the heart. Apocynum will increase the tonicity of the heart, and its nervous structure, acting in harmony with cactus. It will also promote the removal of any serous accumulations. Echinacea should be given in large doses for some weeks, especially if pus be present in the sac.
The Eclectic Practice of Medicine with especial reference to The Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.