Adherent Pericarditis


Categories: Uncategorized
Sources: Disturbances Of The Heart

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. These adhesions between the two surfaces of the

pericardium may be general throughout the entire pericardial sac, or

they may be limited to some one or more parts of the pericardium.

Perhaps one of the most frequent points of adhesion is the anterior

part of the pericardium, while the apex is the part most likely to

be free, even when other parts of the pericardium have grown

together. This freedom of the apex is probably due to the constant

and more extensive motion of the apical portion of the heart, and is

the reason that it has been suggested, as referred to under acute

pericarditis, that, other conditions not contraindicating, the

patient may be allowed to move about a little during convalescence

to cause the heart to beat more actively. Sometimes the surfaces of

the pericardium are not closely adherent to each other, but bands of

adhesion stretch from one surface to the other.



After adhesions have taken place between the two layers of the

pericardium, the action of the heart is impaired, serious

interference with the cardiac action may develop, and sudden death

may occur. If the heart is given all the rest possible during the

acute phase of the disease, there will be less likelihood of the

surfaces becoming so irritated that adhesions readily form. Anything

which permits complete absorption and resorption of tile exudate

will tend to prevent these hampering adhesions. If the adhesions are

such as to cause irregular heart, recurrent pain and the danger of

sudden death, surgical help has been suggested. This surgical

procedure is to remove a portion of the ribs, perhaps of the third,

fourth and fifth, to allow the heart more freedom of action to

compensate for the impairment of its activity from the adhesions.

Such an operation was first suggested by Brauer of Heidelberg in

1902.



The question of the best method of producing anesthesia in this

condition of the heart is a serious one. A patient might die during

the anesthesia; but he might also die at any time from cardiac

spasm. In certain instances, in adults, local anesthesia might be

sufficient. Pain reflexes, however, would be serious. Such an

operation would be indicated when the apex is fixed so that there is

a constant sensation of hugging of the heart at the fourth and fifth

ribs, with paroxysms of pain and cardiac weakness.





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