Hemopericardium.

Definition.—Hemopericardium is an infiltration of blood into the pericardium.

Etiology.—This is entirely distinct from the hemorrhagic effusion that occurs in the course of tubercular, cancerous, and cachectic pericarditis, and is most frequently the result of a rupture of an aneurism of the aorta or coronary arteries, and in very rare cases from rupture of the heart. It may also arise from injuries such as bullet wounds, fracture of the ribs, sternum, etc.

Symptoms.—The symptoms vary, and depend altogether upon the exciting cause. Where hemopericardium is the result of a rupture of the myocardium or an aneurism of the aorta, the patient is suddenly seized with excruciating pain, a deathly pallor or dusky hue overspreads the face, and the patient dies quite suddenly. When due to rupture of a small aneurism of the coronary artery or one of its branches, and but a small quantity of blood finds its way into the pericardium, the results are not so serious, though it is attended by dyspnea and a sense of fullness in the pericardial region. If the infiltration continues, the distention becomes extreme, the dyspnea painful to observe, the pulse weak, and the patient dies of exhaustion. The physical signs are the same as in hydropericardium.

Diagnosis.—The diagnosis is often made only during an autopsy. When a person is known to have had an aortic aneurism, or a myocarditis, and is suddenly seized with excruciating pain, becomes pallid, followed by collapse and death, hemopericardium may be suspected. When the patient has suffered violence by a knife-stab, bullet wound, etc., the diagnosis is not so difficult.

Prognosis.—The prognosis is almost always unfavorable, though aspiration, followed by judicious treatment, has resulted favorably in a few cases.

Treatment.—Stimulants, such as strychnia, nitroglycerine, and camphor and ether, hypodermically to support the heart, will be used, and absolute quiet and rest must be enjoined. If the distention is great, aspiration should not be delayed. Eichhorst reports a case where he averted death by this measure. Should the patient survive the first few days, the treatment would be symptomatic, the remedies used in hydropericardium and pericarditis being chiefly used.

Aspiration might be followed by the introduction of a pint of normal saline solution directly into the circulation, with the hope that its effects would prove of permanent value.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.