PERICARDITIS.

Definition. Frequency in different genera. Causes, rheumatic,

traumatism, extension from pleurisy. Unwholesome buildings and

localities, debility. Symptoms, chill, reaction, pleuritic symptoms,

hyperthermia, tenderness behind left elbow only, friction sound

synchronous with heart beat, later it is lost and heart sounds are

muffled, increased area of dulness on percussion, oppressed breathing,

venous pulse, patient statant, little fever in chronic cases.

Traumatism from the stomach, digestive disorder, grunting, dropsy

under the sternum with little fever at first. Lesions, as in pleurisy,

obliteration of pericardial sac. In traumatism from stomach the

foreign body is formed in the cardiac end of a band of lymph extending

to the reticulum. Treatment, in chill, after reaction, medicinal

measures as in pleurisy, local applications to the region of the

heart. Paracentesis, insertion of needle, antiseptic precautions.

Chronic pericarditis in oxen.

_Definition._ Inflammation of the strong fibro-serous sac in which the

heart is contained and which is reflected on the muscular substance of

that organ so as to form its external covering.

This is the most common inflammatory disease of the heart and has been

met with more frequently in horses and cattle than in the smaller

quadrupeds.

_Causes._ It frequently coincides with or follows other diseases such as

_influenza_, _pleuro-pneumonia_ and above all _rheumatism_. In cattle

and goats wounds from sharp pointed bodies, (needles, pins, nails,

etc.), which have been swallowed with the food and have passed through

the walls of the second stomach, the diaphragm and pleura to the heart

constitute a frequent cause in cattle. The pericardium has been

punctured by a fractured rib and has been implicated in inflammation

attendant on an abscess or other lesion in the walls of the chest.

Besides these the general influences which cause uncomplicated attacks

of the disease are the same as those producing pleurisy, peritonitis,

rheumatism and inflammation of serous membranes generally. These are

sudden changes from heat to cold, cold winds, cold draughts, drenching,

chilling rains in animals already overheated and exhausted, or prolonged

exposure in severe weather, in low states of the system. Leblanc justly

remarks that “with the morbid influences which appear specific, there

often coincide intemperate seasons, badly arranged buildings, a want of

sufficient attention to the conditions of health, and in the case of

herbivora, wet, cold, and badly exposed pastures.” In other words

whatever deteriorates the health and vitality predisposes.

_Symptoms._ These are less characteristic than in man owing to the

smaller portion of the heart exposed, but they are usually marked enough

to permit a recognition of the disease. _Acute form._ The affection is

ushered in by chill, general fever, hyperthermia, (103° to 104°),

staring coat, hot, dry mouth, dilated nostrils, excited, difficult

breathing, double lifting of the flank with each expiration, the

existence of a prominent ridge from the lower end of the last ribs along

the flank to the outer angle of the hip bone, as in pleurisy, pinched,

anxious expression of countenance, fixed eyes, accelerated, full, hard

and often wiry pulse, and tenderness when the ribs behind the left elbow

are pinched or struck. The same tenderness is noticed particularly in

the ox and smaller quadrupeds when pressure or compression is made

beneath the breast bone. Auscultation over the lower ends of the fifth

and sixth ribs and their cartilages detects a friction or rubbing sound

in the early stages and until liquid has been thrown out into the

pericardial sac. This sound may be at first the finest possible

creaking, afterward increasing to a distinct rubbing, is synchronous

with the beat of the heart, and usually with the first sound. It is

distinguished from the friction sound of pleurisy in occurring

rythmically with the sounds of the heart and not with those of

breathing, and from sounds produced in the interior of the heart by its

absence when auscultation is made over the carotid or other large

artery. This friction sound is lost when serous effusion takes place

into the pericardium, but reappears when the liquid is absorbed in the

process of recovery. Until effusion takes place the impulse of the heart

is strong, often irregular, in force, and sometimes accompanied by a

purring tremor or, according to Leblanc, a metallic tinkle.

When effusion has taken place the pulse is weaker and softer, irregular

or intermittent, the impulse of the heart is weaker, the friction sound

is lost, and the area of dulness corresponding to the heart is

increased. Percussion shows it to extend higher than three inches above

the breast bone in the horse and more than two or two and a half inches

transversely. It is distinguished from the effusion of pleurisy in this,

that the dulness is confined to the anterior part of the chest, having

the outline of an inverted cone, and does not extend backward along a

horizontal line, and, in solipedes, in not showing equally on both

sides. In the smaller animals it may be distinguished by not always

occupying the dependent part of the chest when the animal is placed in

different positions. As the effusion increases, the heart’s sounds,

previously strong, become first muffled, then more and more distant

until they may become altogether imperceptible. The difficulty and

oppression of the breathing increases, the nose is protruded, the eyes

more rigidly fixed, and the face more haggard; a venous pulse,

apparently due to the compression of the heart and large veins by the

fluid, is seen in the lower ends of the jugulars, and the animal

obstinately stands as indeed the solipeds do all through the disease. At

this advanced stage dropsies of the limbs, sheath, and other dependent

parts of the body are frequent.

A painful cough is sometimes though by no means invariably present

throughout the disease. Emaciation takes place rapidly and in the more

acute cases death ensues in five to eight days. A fatal issue may be

delayed until after three weeks or the affection may merge into a

_chronic form_.

=Chronic Pericarditis= is sometimes seen in the ox without any preceding

acute attack. This is manifested by the local symptoms without the

accompanying acute fever. Along with a _slight_ fever, there is the

oppressed breathing aggravated by exertion, the weak irregular or

intermittent pulse, the weak or distant heart sounds, the absence of

respiratory sounds and the dullness on percussion over a space

represented by an inverted cone at the anterior part of the chest on

each side, the venous pulse in the neck and the general tendency to

dropsy.

If the _pericarditis_ has been the result of sharp pointed metallic

bodies swallowed and afterwards making their way to the heart, it is

sometimes preceded by eructations, tympany, difficulty in swallowing or

in rumination, and by dropsy under the sternum, but more frequently the

heart symptoms are the first to be noticed. It is not attended by the

high fever of other pericarditis.

_Post Mortem Appearances._ These do not differ materially from those of

pleurisy, to which accordingly the reader is referred. The effusions and

false membranes are of course localized in the sac of the pericardium. A

frequent termination is a permanent adhesion of the pericardium

throughout more or less of its extent to the surface of the heart. In

cases of death the serous effusion is commonly colored with blood though

mostly from a _post mortem_ infiltration of blood from the congested

lungs. The effusion has been known to measure fifteen litres in the

horse. It may be purulent or combined with fœtid gases, particularly in

traumatic cases. After mild attacks white patches (milk spots) are often

left extending, it may be only through the pericardium and in other

cases reaching into the muscular substance. At a less advanced stage the

false membranes are yellow, with a rough or villous surface, they may be

softened from fatty degeneration or they may be more or less completely

calcified.

When the cause has been perforation by a metallic body, it will be found

surrounded by exudate enveloping a canal or band extending to the

diaphragm or stomach.

_Treatment._ Pericarditis often proves fatal but it is by no means

invariably so in uncomplicated cases. There is especial danger when

serous effusion is excessive, when it occurs in a weak and debilitated

subject, or when it is complicated by pleurisy, influenza or rheumatism.

The preliminary chill may be met by the measures advised for the rigor

of pleurisy, but if the malady is developed other treatment is required.

The medication is still essentially as for pleurisy, only the primary

disease (rheumatism, influenza, pneumonia) must be specially attended to

when such is present. Acute pain may be met by carefully graduated doses

of opium or aconite and by the moist jacket or fomentations. Some employ

icebags to soothe at once inflammation and pain and in the absence of

rheumatism these may be resorted to. In the small animals leeches may be

applied over the cardiac region. Dry cupping is a good alternative

applicable to all.

An active purgative is demanded unless the affection is attended by a

low type of fever or has occurred during the course of an epizootic

disease (Horse 5 to 7 drachms aloes, cow 1 to 2 lbs. Epsom Salts, dog 1

oz. castor oil). After the walls of the chest have been well fomented

they may be enveloped in a large mustard poultice which must be

continued until a considerable effusion has taken place beneath the

skin. To moderate and control the heart’s action give digitalis (horse

and ox ½ drachm, dog 2 to 4 grains) four times a day. After the

purgative has acted an ounce of nitrate or acetate of potass may be

given daily to the larger quadrupeds (1½ drachms to sheep and pigs, and

20 grains to dogs) in the drinking water. These agents together with the

digitalis must be pushed to the largest doses when the effusion has

taken place abundantly and when it threatens to dangerously interfere

with the heart’s action. Pilocarpin is a dernier resort, to be used with

caution. In similar circumstances, ointment or tincture of iodine should

be freely applied over the chest in the region of the heart. Mustard and

other vesicants repeatedly applied often greatly hasten the reabsorption

of the liquids.

From the first the animal must be warmly clothed and every means

employed to obtain free circulation and warmth on the surface. The legs

must be well rubbed and wound in warm flannel bandages, or this failing,

may have mustard freely applied to them. Warm injections must be at the

same time thrown into the rectum and will benefit by soliciting the

action of the bowels as well as in raising the temperature of the

surface generally. The food allowed should be warm mashes of wheat bran,

boiled linseed and similar agents in small quantities.

If the amount of effusion threatens a fatal result, it may be drawn off

by a cannula and trochar introduced between the cartilages of the fifth

and sixth ribs, by a valvular wound and with antiseptic precaution (see

hydrothorax), care being taken to avoid puncturing the heart itself.

The trochar or aspirator needle should be pushed in a direction upward

and inward until resistance ceases or it is felt that the heart has been

touched. A caoutchouc tube may now be attached to it and allowed to

depend twelve or eighteen inches, and its lower end should be plunged in

a weak solution of boric acid or other antiseptic. This avoids the

entrance of air and insures against the introduction of ærial bacteria.

When the vital powers are being exhausted stimulants must be given to

support the animal, combined with iodide of potassium. (See advice

concerning the allied condition in _Hydrothorax_).

In the _chronic pericarditis of oxen_ the fatality is greater. Treatment

consists mainly in counterirritants and powerful diuretics employed in

doses determined by the strength of the animal, and combined with

stimulants and tonics as in the advanced stages of the acute disease.

In complicated forms of pericarditis attention must be given mainly to

the constitutional affection, thus in _influenza_ a stimulating and

supporting treatment is demanded, and in _rheumatism_ colchicum, acetate

of potass, salicylate of soda, salol and similar agents must be freely

administered, though not to the exclusion of counterirritants to the

region of the heart, and other measures demanded by the heart diseases.