Diseases of the heart and arterial system : Designed to be a practical presentation of the subject for the use of students and practitioners of medicine.
- Babcock, Robert H. (Robert Hall), 1851-1930
- Date:
- 1910
Licence: Public Domain Mark
Credit: Diseases of the heart and arterial system : Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![sometimes found also that the intensity of the murmur is affected in one way or another by the patient's position, being louder in the erect, weaker in the recumbent posture or the reverse. In some cases also the intensity is affected by respiration, being louder when by forced inspiration the pericardial layers are brought into lirmer apposition, and contrariwise enfeebled when separated by expiration. The reverse of this has been observed, however. There is nothing in acute pericarditis per se to cause abnor- mal alteration of the heart-sounds. As stated by Roberts, either tone may be obscured by an unusually loud and harsh friction- murmur, but in general they are heard through the murmur in those cases in which they happen to l)e synchronous. When the inflammatory process has invaded the myocardium or has weak- ened it through dangerous dilatation, the cardiac sounds are likely to become feeble, and the first at the apex may be more or less toneless, but there is nothing in this peculiar to pericarditis. Stasis in the pulmonary system is evinced among other things by undue accentuation of the ])ulmonic second tone, while in conse- quence of the feeble discharging power of the left ventricle the aortic second sound becomes enfeebled. Diagnosis.—The diagnosis of dry pericarditis is not as a rule attended Avith insuperable difficulty. In cases in which it is latent or its symptoms are masked l)y those of the primary affection it may be easily overlooked. In most instances its presence is declared by the history of an antecedent or associated rheumatism, by prsecordial pain, etc., and by the character- istic rubbing thrill and murnuir. When the anamnesis and symp- tomatology are negative, reliance must be placed upon the auscul- tatory phenomena, and these failing, a correct diagnosis is hardly possible. Differential Diagnosis. — This concerns acute endocarditis, pleurisy, and pneumonia. The diagnosis of acute endocarditis is hardly possible unless valvuhir murmurs and other definite changes in the soun<ls and shape of the heart and embolic phenom- ena are detected. The differentiation of endocardial from exocar- dial murmurs is based on the laws concerning the latter just de- scribed, aiul as a rule is not particularly ditHcult if due attention is paid to their rhythm.](https://iiif.wellcomecollection.org/image/b21229533_0084.jp2/full/800%2C/0/default.jpg)
