Auscultatory Findings in Pericardial Effusion and in Ventricular Aneurysm

heart soxiii(l5 may h)e iiiarke(dlv-(limiillished ill the pIresene of a largre pericar(lial effusiom.1-: ()1 the other hand, with a l)ericardial effusion of moderate size, the heart sounds mnabitain normal intensity. Likewise, the x-ray alid eleetrocardiogyrallm Illay llot show tylpical changles'. In11such eases a Igrio(ar(liogLraphy is sometimes u15ed(for (diagtosi.s;; soiiietimnes a diagnllosti(1)ericardial aspirationi is atteml)ted with an exploratory nee(dle, or direct operative exploration is l)erformlled. A useful sinll ill selected cases of l)ericar-(ial effusiiion has b)eeli the effeet of position onl initeisity of heart souli(ls. Ill normal in-dih-iduals, as shlownl ill fiure 1, heart sounds remnaili the same or become louder when the subject turns oii his stomach. Wheii the pa-tieit turns on his stomach auseultation is easier aiid more (otivenienit if the patieiit 1)ro)s hiiniself up oii his elbows. The heart souiilds may become louder, presumlally. because the heart is in (loser proximity to the c'hes't wall, and iii turI', to the stethoscope. (On the other hand, ini soiiie cases of pericar-(ial effulsion, as illustrated in figture 22 (top), the heart soundcs became fainter instead of r'einiainilig, the same or lecoliig louder. Ill ome case the (diagilosis of heriealdial effusion was iiot evident at that heartidular time bh the usual eli iieal evaluation, but subsequently1 there developed typical signs of pericardial effusion which was verified at post mortem examination when a tumor involvimig the peri-cardiuni was found. The sigii was most useful in the ease of a, 45-vear-old womnami with rheumiatic mitral 1034 steniosis and aorisi lcieiicv(,otie steIosis and iillvsllffi(it(11(1N-x and1 tric*uspide ilglfeil(5(i, 2). Thlw heart was enlargted as a result of the valvular lesions and the p)atiellt 's (linlical cond(Iitioni was nloted(to he stea(lily worsenu11(. 'I'lle possib)ility of pericardial effusion arose, hut eould not be established b)v x-ray or flloroscopic examination, or (trOcardiO-gYramii. 0n turning the l)atieut from her l)a(.1; to her abdomen, the heart sounds anid murmurs were note(d, and demonstrated oni the phono(cardiogranm, to signifieantly (lee rease. Ier (onditionl continued to deteriorate, and approximately 1 week later the heart, b)V x-ray, had significantly inlcrease(l ill size and the silhouette was niow suggestive of lperi(ar-dial (effusioi. Uider direet vision in the operating room, ap)p)roximately 1,()(0 ml. of b)loody fluid was removed from the p)erieard ial caVitv. F'ollowingr this, her coniditioii iml)roved EFFECT OF POSITION ON NORMAL HT. SDS.