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Updated: June 8, 2025
These men may add weight from the age of 40 on, or they may be thin and wiry. Besides the hypertension there is likely to be a too sturdily acting heart, which is often hypertrophied, and there is an accentuated closure of the aortic valve. There may be dizziness, or no head symptoms at all. Nicotin is likely to be an etiologic factor in this class.
Symptoms of pressure on the structures in the neck, similar to those produced by aortic aneurysm, occur. The pulses in the right upper extremity and in the right carotid and its branches are diminished and delayed. Pressure on the right brachial plexus causes shooting pain down the arm and muscular paresis on that side.
Here there is a gradual failing of the heart muscle, with circulatory insufficiency, until the final heart pang occurs. Anginal attacks before the age of 40, presumed, from a possible narrowing of the aortic valve, to be due to coronary sclerosis, are frequently due to a long previous attack of syphilis.
We have had cases under observation in which the treatment referred to has been followed by such an amount of improvement that the patient has been able to resume a laborious occupation for one or more years. Christopher Heath found that improvement followed ligation of the left common carotid in aneurysm of the transverse part of the aortic arch.
This is surrounded by a sheath of connective tissue, at first merely membranous, later becoming cartilaginous or gristly. Pieces of cartilage extend upward over the spinal marrow, and downward around the great aortic artery, forming the neural and hæmal arches.
A careful consideration of the position in which the swelling first appeared, of the direction in which it has progressed, of its pressure effects, and of the condition of the pulses beyond, may help in distinguishing between aortic, innominate, carotid, and subclavian aneurysms. Skiagraphy is also of assistance in recognising the vessel involved.
Rheumatism is the cause of most instances of cardiac disease which date back to childhood or youth, while arteriosclerosis and chronic infection cause most cardiac diseases in the adult. In the former case it is the mitral valve which is the most frequently affected, while in the latter it is the aortic valve.
If endocarditis occurs in the fetus, it is the right side of the heart that is affected; in children and during adolescence it is most frequently the mitral valve that is involved; while in the adult or in old age it is the aortic valve that is most liable to become diseased.
If such narrowing occurs without aortic insufficiency at the age at which it usually occurs, it may not seriously affect the heart. It may follow acute endocarditis, but it most frequently follows chronic endocarditis or atheroma, in which the aortic valves become thickened and more or less rigid; this condition most frequently occurs in men.
These appearances were propagated into the arteria innominata. The aortic valves were indurated...." He remarks, "The delay of blood in the aorta, in the heart, in the pulmonary vessels, and in the vena cave, would occasion the symptoms of which the woman complained during life; namely, the violent uneasiness, the difficulty of breathing, and the numbness of the arm."
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