hepatic, and praecordial pulsations in constrictive pericarditis

A study of the pulsatile features in constrictive pericarditis has been attempted in ii cases. The diagnosis was confirmed in 5 cases at operation. The expected increase in the frequency of the condition in certain localities is put forward. Venous neck pulsations with particular reference to the pathogenesis of the x and y descents are discussed. Hepatic pulsations previously not sufficiently stressed in this disease are described and are graphically documented. They are found to conform, though to a lesser magnitude, with the venous neck pulsations. Apex cardiography has been utilized to study praecordial pulsations. A reproducible curve was obtained from the praecordium in all cases. The curve appears characteristic of the condition and consists of a small isometric contraction phase, low E point, a wide systolic trough, a small isometric relaxation phase, a steep rapid filling wave (RFW), and a rebound wave, which is followed by a diastolic plateau without or including an ill-defined A wave. The curve is characteristically biphasic and the rebound wave rather than the E point forms its summit. Restoration of the abnormal cardiogram to a normal pattern follows successful pericardiectomy. The genesis of the abnormal curve is discussed.