Spodick - The Pericardium: A Comprehensive Textbook (Fundamental and Clinical Cardiology)
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The Pericardium: A Comprehensive Textbook (Fundamental and Clinical Cardiology)
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Presents up-to-date coverage of the pericardium in health and medical and surgical disease, integrating recent advances in understanding normal and abnormal pericardial physiology and immunology, acute and chronic pericarditis, effusion and tamponade, and imaging methods for effusion and constriction. Incorporates clinical, hemodynamic, investigative, and experimental work conducted by leading interdisciplinary researchers--including never-before-published reports--on the normal and diseased pericardium.
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The opened normal pericardium and heart in situ. The epicardial mesothelium is transparent; the parietal pericardiummesothelium and fibrosais translucent. A curved probe is in the pericardial tranverse sinus (see also Figures 2.1 and 2.3). (From Spodick, Acute Pericarditis, 1959; author's copyright.)
Page i
The Pericardium
A Comprehensive Textbook
David H. Spodick, M. D., D.Sc., F.A.C.C., F.C.C.P., F.A.C.P.
Professor of Medicine University of Massachusetts Medical School; Director of Clinical Cardiology and Cardiovascular Fellowship Training Saint Vincent Hospital Worcester, Massachusetts
Page ii
Library of Congress Cataloging-in-Publication Data
Spodick, David H. The pericardium : a comprehensive textbook / David H. Spodick. p. cm. (Fundamental and clinical cardiology ; v. 27) Includes index. ISBN: 0-8247-9316-1 (hardcover : alk. paper) 1. PericardiumDiseases. I. Title. II. Series. [DNLM: 1. Pericardium. 2. Pericarditis. W1 FU538TD v.27 1997 / WG 275 S762p 1997] RC685.P5S725 1997 616.1'1dc20 DNLM/DLC for Library of Congress 96-43173 CIP
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This book is printed on acid-free paper.
Copyright 1997 by Marcel Dekker, Inc. All Rights Reserved.
Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Marcel Dekker, Inc. 270 Madison Avenue, New York, New York 10016
To Carolyn, for her love and care and her support and forbearance while this book was being written.
Page v
PREFACE
"Pericardiology" is a term that might express concisely the comprehensive scope of this book. I used it to name a course at Heart House, headquarters of the American College of Cardiology in Bethesda. Indeed, this book attempts to express the fruit of an exceptional personal exposure to pericardial disease in the context of recent advances in medical and surgical diagnosis and therapy and in physiology, immunology and oncology and infectious, metabolic and traumatic diseases. It relies extensively on the work of others as well as personal clinical and laboratory observations, formal investigations and publications.
Autobiographical Excursus as Preface
I am often asked: "How did you get so interested in pericardial disease?" The answer is that it was inevitable, given extraordinary opportunities to diagnose, manage and investigate pericardial disorders, coupled with a deep personal interest in physiology and bedside medicine. I hope readers will forgive me for expanding on this answer in highly personal, indeed autobiographical, terms.
As a junior house officer, I saw sporadic cases of pericardial disease and a few weeks of what must have been a small enterovirus epidemic in England while I was with the U.S. Air Force Medical Service. As a senior resident at New England Medical Center, I had two patients with severe tuberculous pericarditis, one with cardiac tamponade that resolved after pericardiocentesis and another with tamponade followed by accelerated effusive-constrictive pericarditis. Inspired by a consummate teacher, Louis Selverstone, I became
Page vi
fascinated with tamponade physiology and plotted these patients' venous pressures and roentgenographic responses to the disease and its treatment. In both cases, increasing venous pressure fell dramatically after pericardial drainage, along with shrinking of the cardiopericardial silhouette. However, though the less fortunate second patient maintained his newly reduced heart shadow, within days the venous pressure reascended, an abnormal third heart sound appeared and he required pericardiectomy. After a search at the Boston Medical Library, I published these cases with an exhaustive literature review. This also stimulated two publications in the Bulletin of TuftsNew England Medical Center: "Observations in Cardiac Tamponade: Physiological Considerations" and "Pain Mechanisms in Pericardial Disease." Later, first as a cardiology resident and then as a Special Postdoctoral Fellow of the National Heart Institute under David Littmann, my treatment of a succession of tamponaded patients led to publication of a small series on electrical alternation. Thereafter, during my 19 years at the Lemuel Shattuck Hospital, the original patient population provided a veritable pericardial pandemic. Cases were varied, frequently complicated, and numerous owing to very large specialized units including chest disease, rheumatology, oncology, radiation therapy and renal dialysis, in addition to the other in- and outpatient services of a large hospital. My private affiliation at neighboring Faulkner Hospital extended these opportunities to observe, manage and consult on additional patients.
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