Hydropericardium or pericardial dropsy is a serous transudation into the pericardial sac, being similar to hydrothorax and ascites. Etiology : Hydropericardium is a secondary affection, due to a venous stasis, the result of valvular disease, myocardial degeneration, or it may result from disease of the lungs, pleura, kidneys, pericardium or mediastinum.
Pathology: The fluid in the pericardial sac is clear, of a greenish or yellowish tint; if blood is present it is reddish, or if due to broken down coloring matter of the blood, it is a dirty brown color. The specific gravity is usually about 1.015. Epithelial and round cells, granular in character, are found at times. The amount of fluid varies from one to four thousand c. c. At a post mortem examination the pericardium is found to be distended in proportion to the amount of fluid present. The serous surface is pale, smooth and shiny, showing no fibrinous exudate. If the fluid has accumulated slowly the pericardium is thickened, while at other times it is thinner than normal. The heart is generally pale and flabby, its right side being considerably dilated.
Symptoms: It should be remembered that hydropericardium is but one phase of a great pathological condition and its symptoms are often overshadowed by the original disease. Its appearance is more frequently indicated by a sub-normal temperature than by a pyrexia. Attacks of syncope and dyspnea are common, while cyanosis and edema are present in a varying degree. If the effusion is marked the patient sits up, or leans forward, resting his elbows on his knees or on an object in front of him. The pulse is irregular, frequent, compressible and empty. The precordia may bulge and the intercostal space be distended. The veins of the neck are surcharged with blood. The cardiac impulse is faint if at all perceptible. The heart’s sound and any murmur that may have been present become faint. There is no friction sound. The liver is usually enlarged and ascites is present. The urine often contains albumen and is diminished in quantity. Edema of the lung or hydrothorax may be detected at the base of the lungs.
Diagnosis : This is based upon the presence of an effusion without pericarditis and the presence of other diseases capable of producing it.
Prognosis: This depends upon the cause. If this is amenable to treatment it is good, if not it is grave.
Treatment : This is the treatment of the cause to a great extent. The use of dry foods, and the employment of those means that will eliminate the fluids from the body are beneficial. In cases where the symptoms appear to indicate it, paracentesis should be resorted to.
Apocynum cann: This remedy has won for itself the chief place in the relief of dropsical conditions. Whether they be in the form of anasarca, ascites, edema of the extremities, hydrothorax, or hydropericardium, the result of a suspended action of the kidneys, no structural disease being present. There is a sinking feeling at the pit of the stomach with great thirst, but water disagrees, and is vomited up at once. The bowels are constipated, and the urine is scanty and of a dark color. The dyspnea is so great that the patient cannot lie down and can scarcely speak. The best results will be obtained from this remedy when it is used in doses of from one to five drops of the tincture, or one or two drachms of a decoction.
Arsenicum alb. : This remedy should be thought of when there is rapid and great prostration, with sinking of the vital forces, marked anxiety and fear of death. The patient is sad and irritable, is much emaciated, and has a dry red tongue. There is great thirst. He drinks but little at one time, but he wants it often. The stomach feels distended and on fire. The nausea is accompanied with great weakness, anxiety, and recurs at regular intervals and is worse after midnight. Ascites, the result of disease of the heart, liver, spleen, kidneys and post-scarlatinal dropsy. There is great dyspnea with fear of suffocation. The patient is obliged to sit up. Great anguish is present. There are copious effusions in all the cavities.
Apis mellifica: When this remedy is indicated the pains are of a burning and stinging character, and urine is scanty and of high color; the face is swollen, pale, waxen and edematous. There is loss of appetite, with but little or no thirst. It produces anasarca and general dropsy, with scanty urine, and suffocation so that the patient cannot lie down.
Digitalis purp : This remedy has already been mentioned in several diseases but it will be found of service here when there is an organic disease of the heart. In the earlier stages the breathing was only interfered with periodically; especially at night, while later it is continually bad, but still has paroxysms. The patient cannot lie down but sits with the head thrown back or inclined forward. The jugular veins are distended, the face is livid and dusky, the pulse is now frequent, irregular and feeble. The urine is scanty and highly colored, and the physical examination indicates organic heart disease.
Other remedies that might be studied with advantage in this connection are Kali Carb., Kali Iodium
Excerpted from: From Diseases of the Heart –A.L. Blackwood, 1901