Diseases of the chest and the principles of physical diagnosis . th the pericardialdamage or independently. Pathological Physiology.—The mechanical effects upon the circula-tion due to the adhesions are described by Hirschfelder as follows: (1)^ Norsk Magazin for Laegevidenskoben, October, 1914, Ixxv. 666 DISEASES OF THE PERICARDIUM, HEART, AND AORTA The work of the ventricle is increased bj the tug upon the adhesions.(2) The fining of the heart may be hindered by strangulation of the venacava. At each contraction the heart must not only drive out the blood,but must pull on its harness of adhe
Diseases of the chest and the principles of physical diagnosis . th the pericardialdamage or independently. Pathological Physiology.—The mechanical effects upon the circula-tion due to the adhesions are described by Hirschfelder as follows: (1)^ Norsk Magazin for Laegevidenskoben, October, 1914, Ixxv. 666 DISEASES OF THE PERICARDIUM, HEART, AND AORTA The work of the ventricle is increased bj the tug upon the adhesions.(2) The fining of the heart may be hindered by strangulation of the venacava. At each contraction the heart must not only drive out the blood,but must pull on its harness of adhesions. The additional work willdepend on the tightness of the adhesions and the weight and rigidity ofthe structures pulled. Adhesions between the ribs and diaphragmcause the greatest effort. (3) The emptying of the heart and the flowthrough the aorta may be hindered by the tugging of adhesions upon thearch of the aorta. As the result of the increased work the heart hypertrophies just asit does in the presence of chronic endocarditis. As degenerative changes. Fig. 381.— Mediastino-pericarditis. are relatively common in the heart muscle, either as the result of thefibrosis extending in from the pericardium or as an independent affection,compensation is apt to fail if the heart is subjected to an undue compensation fails, it may present the clinical picture of failure ofthe left ventricle with marked dyspnea or pulmonary edema; or it maymanifest itself chieflj^ by the signs of venous stasis such as occur in failureof the right ventricle. Hirschfelder states that the type of broken com-pensation will depend on whether the adhesions are greatest over theleft or over the right ventricle. Death is seldom due to the pericarditis itself. It occurs either as theresult of degenerative changes in the heart muscle or to exhaustion ofthe heart as the result of some intercurrent affection. DISEASES OF THE PERICARDIUM 667 The relative frequency of the condition and the fact th
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