Since the time of Skoda,1 three pulsatory findings have been considered to be essential for the diagnosis of adhesive pericardial disease. They are: the systolic depression over the cardiac area; the diastolic cardiac thrust and the absence of the apical thrust.
Adhesions betwen the heart and the pericardium, particularly along their caudal aspect, inhibit greatly the change in shape which during systole would lead to elevation of the heart and with it to a thrust of the apical portion against the thoracic wall. Hence the apical thrust is usually absent in adhesive pericardial disease. This diagnostic finding, however, should not be evaluated too highly, because the apical thrust is often absent in the adult and, in addition to adhesive pericardial disease, there are a good number of other factors capable of diminishing or abolishing the apical thrust. Bamberger2 has already pointed out and my colleagues and I have
DRESSLER W. PULSATIONS OF THE WALL OF THE CHEST: IV. PULSATIONS ASSOCIATED WITH ADHESIVE PERICARDIAL DISEASE. Arch Intern Med (Chic). 1937;60(4):654–662. doi:10.1001/archinte.1937.00180040090006
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