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The left ventricle with its enormous strain is perhaps the first part to dilate, thus enlarging the opening of the defective mitral valve. The left auricle is then unable to cope with the increased amount of regurgitant blood, and there is in consequence congestion in the lungs, and the right ventricle finds the pressure ahead in the lungs greater than it can well overcome.
You'll never be anything but a sheriff's officer," put in Metivier, striking Mitral amicably on the shoulder; "I like that, I do!" "Seize Monsieur Clement des Lupeaulx in our clutches," continued Mitral; "Elisabeth has discovered how to do it, and he is "
Tobacco, besides increasing the blood tension and thus perhaps injuring the aortic valve, may weaken the heart muscle and cause disturbance and irritation and perhaps inflammation of the mitral valve. There is no age which is exempt from valvular disease, but the age determines the valve most liable to be affected.
He had mitral regurgitation, cirrhosis of the liver, Bright's disease, an enlarged spleen, and incipient dropsy. I gave him a lecture about the necessity of temperance, if not of total abstinence; but I fear that my words made no impression. He chuckled, and made a kind of clucking noise in his throat all the time that I was speaking, but whether in assent or remonstrance I cannot say.
Such irregularity perhaps most frequently occurs with valvular disease, especially mitral stenosis and in the muscular degenerations of senility, as fibrosis. Atropin has been used to differentiate functional heart block from that produced by a lesion. Jour. Med. In the first the heart block is induced by digitalis. This was entirely removed by atropin.
The left ventricle may, however, become weakened, either by some sudden strain or by a chronic myocarditis, and relative insufficiency of the mitral valve may occur. The subsequent symptoms are typically those of loss of compensation.
Valvular disease at the aortic orifice is much less common than at the mitral orifice, and while stenosis or obstruction is less common from rheumatism or acute inflammatory endocarditis than is insufficiency of this valve, a narrowing or at least the clinical sign of narrowing, denoted by a systolic blow at the base of the heart over the aortic opening, is in arteriosclerosis and old age of frequent occurrence.
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.
The signs of lack of compensation are generally cardiac distress, rapid heart, insufficiency of the systolic force of the left ventricle, and therefore impaired peripheral circulation, a sluggish return circulation, pendent edemas, and soon, with the left auricle finding the left ventricle. insufficiently emptied, the damming back of the blood is in broken compensation with the mitral lesions.
This is especially true of the liver and kidneys. Mitral stenosis, though less common than mitral regurgitation, is a frequent form of disease of the valves, especially in women. Often this condition is associated with regurgitation; but in a simple mitral stenosis the greatest hypertrophy is of necessity in the right ventricle.
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