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Not infrequently soft systolic murmurs are heard at the pulmonary and tricuspid valves during acute endocarditis. It is rare, however, that these valves are so affected during childhood or adult life as to be permanently disabled. Whether a diminished alkalinity of the blood in rheumatism has anything to do with the cause of the frequent complication of endocarditis has not been determined.
In early childhood it is possible that it may be associated with left-side endocarditis. A special treatment of the heart, if any is needed, would probably not be indicated unless there was associated tricuspid insufficiency, when digitalis might be used. If this rare condition occurs, it is probably congenital.
All the cavities of the heart are lined with a smooth, delicate membrane, called the endocardium. Semilunar valves. 2. Tricuspid valve. 3. Mitral valve. 4. Right auricle. 5. Left auricle. 6. Right ventricle. 7. Left ventricle. 8. Chordæ tendineæ. 9. Inferior vena cava. 10. Superior vena cava. 11. Pulmonary artery. 12. Aorta. 13. Pulmonary veins.
Julia shrank and cast an appealing look at her mother; but the impassive chevalier reported on each organ in turn without moving his ear from the key-hole: "Lungs pretty sound," said he, a little plaintively: "so is the liver. Now for the Hum? There is no kardiae insufficiency, I think, neither mitral nor tricuspid. If we find no tendency to hypertrophy we shall do very well. Ah!
The symptoms of heart strain, if the condition is acute, are those of complete prostration, lowered blood pressure, and a sluggishly, insufficiently acting heart. The heart is found enlarged, the apex beat diffuse and there may be a systolic blow at the mitral or tricuspid valve.
A postmortem examination one year afterward confirmed this, as a contracted cicatrix was plainly visible on the posterior surface of the heart about an inch above the apex, through which the thorn had penetrated the right ventricle and lodged in the tricuspid valve. The supposition was that the thorn had been swallowed while eating radishes.
The valve on the right side is called the tricuspid, because it consists of three little folds which fall over the opening and close it, being kept from falling too far by a number of slender threads called chordæ tendinæ. The valve on the left side, called the mitral, from its fancied resemblance to a bishop's mitre, consists of two folds which close together as do those of the tricuspid valve.
The main danger, however, with a heart with this lesion, occurring coincidently with arteriosclerosis, is a progressive chronic myocarditis. Tricuspid insufficiency, except as rarely found in the fetus, is generally due to a relative insufficiency rather than to an actual disease of the tricuspid valve. In other words, if the right ventricle dilates the valve may be insufficient.
Tricuspid stenosis, pulmonary stenosis and pulmonary insufficiency are rare, and are probably nearly always congenital. The diagnosis as to whether the murmurs heard in the heart are hemic, functional, accidental, or indicative of valvular lesions would be without the scope of this book. It is always presumed that a correct diagnosis has been made, or at least a presumptively correct diagnosis.
It has been found to be associated with such congenital lesions of the heart as an open foramen ovale or foramen Botalli, or with an imperfect ventricular septum, and perhaps with tricuspid stenosis in short, a cardiac congenital defect. The right ventricle becomes hypertrophied, if the child lives to overcome the obstruction.
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