Synonym.—Dropsy of the Pericardium.
Definition.—Hydropericardium is a non-inflammatory condition of the pericardium, attended by an accumulation of sero-albuminous fluid.
Etiology.—Hydropericardium is generally the result of a retarded or interrupted circulation, and is usually an accompaniment of ascites or general dropsy, which is frequently seen in the last stages of chronic nephritis, or old valvular troubles. It also follows scarlatina, nephritis, tuberculosis, cancer, diabetes, degenerative changes in spleen and liver, Addison's disease, and all conditions leading to marasmus.
It may be due to local causes obstructing the circulation of the coronary vessels, to mediastinal tumors, to aneurism, or to thrombus of the cardiac veins. In fact, any disease that gives rise to the formation of fluid in the cavities may be attended by dropsy of the pericardium.
Pathology.—Hydropericardium is not a disease of itself, but is always secondary; hence a varied condition is presented. It may be, there will be structural disease of the kidney, spleen, liver, or heart itself; frequent valvular lesions are found. The pericardium itself remains unchanged.
The accumulated fluid is usually clear, of an amber color, though it may become turbid by the presence of fibrin or red blood corpuscles. It is alkaline in reaction.
Symptoms.—Being a secondary lesion, and coming on insidiously, we find no pronounced or characteristic symptoms other than dyspnea. If the transudation commences in the extremities, gradually invades the peritoneum and the pleura, dropsy of the heart undoubtedly prevails, and the dyspnea is the symptom that confirms the condition. There may be a sympathetic cough due to pressure from the distended pericardium. The physical signs, excepting the friction sound, are the same as in pericarditis.
Inspection.—As a rule, inspection fails to throw any light upon the case: in fact, there are no very reliable physical signs, other than those of pericarditis. The pulse depends upon the condition of the heart, though it is generally small and frequent. If there is excessive distention, the patient will have attacks of dizziness or vertigo. The secretion from the kidneys is scanty, turbid, and presents heavy deposits.
Diagnosis.—The distinction between pericarditis with effusion and hydropericardium is not always easy. If we remember, however, that pericarditis is more of an acute disease, is attended with more or less pain, has the characteristic friction sound, and has a history of being preceded by some one of the infectious fevers, rheumatism, pleurisy, and tuberculosis, the diagnosis becomes more easy.
Prognosis.—The prognosis depends almost altogether upon the disease that gives rise to it. If the heart is in good condition, there being no structural change in its valves, orifices, or muscular tissues, the prognosis is quite favorable. If, however, the process of degeneration has taken place in kidney, liver, lung, or spleen, and these are followed by dropsy, the outlook will be unfavorable, even though the heart be in fair condition. Some very severe cases, however, even when the transudation is excessive and is found in all the tissues, make happy and permanent recoveries.
Treatment.—To one who has never used apocynum in hydro-pericardium, a pleasant surprise awaits him. It is the remedy par excellence. Under its administration the secretion from the kidneys is largely increased, the stools become watery, and the fluid from all the tissues rapidly subsides, the dyspnea is relieved, and the heart's action improves.
Where the remedy can not be retained, the compound officinal infusion of digitalis is a good remedy. Convallaria may be used in combination or alternation, and will greatly add to its efficiency. Cactus adds tone to the heart, and should not be overlooked in this disease.
Where there is severe structural change in any of the important viscera, the treatment will simply consist in using such remedies as will aid the heart and at the same time, as far as possible, carry off the fluid. Where the accumulation is extreme and the dyspnea great, we should perform paracentesis as recommended in pericarditis with effusion.