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Updated: June 8, 2025
The greater the amount of myocarditis, the more doubtful is the heart strength in the near future. The greater the amount of endocarditis, the greater the doubt of freedom from future permanent valvular lesions. This inflammation of the endocardium is generally confined to the region of the valves, and the valves most frequently so inflamed are the mitral and aortic.
The conclusion to be drawn from their experiments is that when there is asphyxia, increased venous pressure, and also a rising blood pressure from the stimulation of carbon dioxid, strychnin is contraindicated. It should be recognized that digitalis very frequently not only does not raise blood pressure, but also may lower it; especially in aortic insufficiency and when there is cyanosis.
If the left ventricle is the most hypertrophied, the apex is also to the left, but the impact is very decided and the aortic closure is accentuated. The term "simple dilatation" may be applied to the dilatation of one or both ventricles when there is no valvular lesion and when the condition may not be called broken compensation. The compensation has been sufficiently discussed.
The rectal explorations may reveal a pulseless state of one or more of the iliac arteries and a hardness and enlargement of the aortic quadrifurcation, but sometimes this palpation fails to disclose any perceptible diminution of the blood current of these vessels. The obturation being incomplete, it may be impossible by palpation to decide that thrombosis really exists.
So well is it developed and so rapidly does it act that it is practically impossible to bleed some animals to death by cutting across any vessel smaller than one of the great aortic trunks.
A peculiar sequence of an aortic aneurysm is perforation of the sternum or rib. Webb mentions an Irish woman who died of aneurysm of the aorta, which had perforated the sternum, the orifice being plugged by a large clot. He quotes 17 similar cases which he has collected as occurring from 1749 to 1874, and notes that one of the patients lived seven weeks after the rupture of the aneurysmal sac.
If it occurs later in life it generally is associated with aortic narrowing, and is a part of the general endarteritis and perhaps atheroma of the aorta. Sometimes it is caused by strenuous exertion apparently rupturing the valve. This form of valvular disease frequently ends in sudden death. On the other hand, it is astonishing how active a person may be with this really terrible cardiac defect.
Next in frequency to mitral insufficiency is aortic insufficiency, which occurs most frequently in men. The cavity of the heart that is most affected by this lesion is the left ventricle, which receives blood both from the left auricle, and regurgitantly from the aorta.
Aortic narrowing or stenosis is a frequent occurrence in the aged and in arteriosclerosis when the aorta is involved. It is not a frequent single lesion in the young. If it occurs in children or young adults, it is likely to be combined with aortic regurgitation, meaning that the valve hay been seriously injured by an endocarditis.
In all cases of sudden death think of angina pectoris and the rupture of an aneurism. Aortic incompetence. Rupture of heart. Rupture of a valve. Rupture of aortic aneurism. Embolism of coronary artery. Angina pectoris. Cerebral hæmorrhage or embolism. Mitral and tricuspid valvular lesions if the patient exerts himself.
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