Physical Diagnosis of Diseases of the Chest (Paperback)

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1903 Excerpt: ...serious of valvular lesions is incompetency of the mitral. It results in most cases from the shortening, stiffening, and thickening of the valve produced by rheumatic endocarditis in early life. It is the lesion present in most cases of chorea (see Figs. 88 and 89). Temporary and curable mitral regurgitation may result from weakening of the heart muscle, which normally assists in closing the mitral orifice through the sphincter-like contraction of its circular fibres. Great muscular fatigue, such as is produced by a hard boat race, may result in a temporary relaxation of the mitral sphincter or of the papillary muscles sufficient to allow of genuine but temporary and curable regurgitation through the mitral orifice. In conditions of profound nervous debility, excitement, or exhaustion, similar weakening of the cardiac muscles may allow of a leakage through the mitral, which ceases with the removal of its cause. Stress has been laid upon these points by Prince, and recently by Arnold. Mitral insufficiency due to stretching of the ring into which the valve is inserted occurs not unfrequently as a result of dilatation of the left ventricle, and is commonly known as relative insufficiency of the mitral valve. The valve orifice can enlarge, the valve cannot, and hence its curtains are insufficient to fill up the dilated orifice. This type of mitral insufficiency frequently results from aortic regurgitation with the dilatation of the left ventricle which that lesion produces, or from myocarditis, which weakens the heart wall until it dilates and widens the mitral orifice. The results of any form of mitral leakage occur in this order: 1. Dilatation or hypertrophy of the left auricle, which has to receive blood both from the lungs and through the leaky mitral from ...