The pulsatory features in the presence of tricuspid regurgitation often show a surprising similarity to those accompanying adhesive pericardial disease, and for this reason there is not infrequently confusion as to the proper diagnosis. Sometimes there is a widespread systolic depression of the wall of the chest in cases of tricuspid regurgitation which now and then markedly exceeds the actual cardiac area. The mechanism of this pulsation, as Lang1has shown, is essentially different from that of the pulsation noted in cases of adhesive pericardial disease. When there is tricuspid regurgitation, the right ventricle is usually enormously enlarged and is in wide contact with the ventral wall of the chest. During systole the right ventricle empties only a small amount of blood into the pulmonary artery; the larger amount flows in the direction of lesser resistance, i. e., into the right auricle and hence into the large veins, primarily