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Updated: June 22, 2025
The lesion which is most apt to cause auricular fibrillation and more or less permanently irregular heart is perhaps mitral stenosis. Another frequent cause of more or less permanent irregularity is the excessive use of alcohol. It also is not quite determinaible whether a heart that is so misbehaving has a recurrence of such misbehavior more readily than a heart which has never been so affected.
I have grave doubts as to my mitral valve, if you would be so very good. The aortic I may rely upon, but I should value your opinion upon the mitral." I listened to his heart, as requested, but was unable to find anything amiss, save indeed that he was in an ecstasy of fear, for he shivered from head to foot. "It appears to be normal," I said. "You have no cause for uneasiness."
On the evening of which we write, Monsieur Saillard, returning from the ministry, found a game of boston in full blast; Elisabeth was advising Falleix how to play; Madame Saillard was knitting in the chimney-corner and overlooking the cards of the vicar; Monsieur Baudoyer, motionless as a mile-stone, was employing his mental capacity in calculating how the cards were placed, and sat opposite to Mitral, who had come up from Ile-d'Adam for the Christmas holidays.
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.
Before the heart muscle actually weakens, the blood pressure has been increased more or less constantly, perhaps permanently, until such time as the left ventricle fails. The left ventricle from tobacco alone, without any other assignable cause, may become dilated and the mitral valve become insufficient.
If the left ventricle becomes dilated the mitral valve may become insufficient, when the usual lung symptoms occur, with hypertrophy of the right ventricle; and if it fails, the usual venous symptoms of loss of compensation follow. This lesion not infrequently causes epistaxis, hemoptysis and hematemesis. Digitalis is always of value in these cases, but it should not be pushed.
The obstacles cleared, he laid his ear to the heart and listened intently. "Mitral regurgitation?" he said, softly, when he rose. The words ended with the rising inflection of uncertainty. Again he listened long; and this time he said, "Mitral insufficiency," with the accent of an assured diagnosis.
To understand the physiology, pathology and the best treatment for broken compensation, it is necessary to study the physics of the circulation under the different conditions. With the mitral valve insufficient, a greater or less amount of blood is regurgitated into the left auricle, which soon becomes dilated.
In this condition if tobacco is entirely stopped, and the patient put on digitalis and given the usual careful advice as to eating, drinking, exertion, exercise and rest, such a heart will generally improve, acquire its normal tone, and the mitral valve become again sufficient, and to all intents and purposes the patient becomes well.
The patient was suffering from mitral insufficiency, with irregular pulse, loss of appetite, enlargement of the liver, and mild jaundice. Temporary relief had been several times afforded by infusion of digitalis. In February, 1879, the condition of the patient suddenly became aggravated. The pulse became very irregular and intermittent.
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