Auricular hypertrophy was recorded as present in II of the 77 eases of severe mitral stenosis, and in 2t of the 96 slighter cases.
The left auricle was stated to have been much dilated in 14 of the 77 cases of severe stenosis, dilated in IS others, and slightly dilated in 7. Among the 96 less severe cases it was much dilated in 8, dilated in 15, and slightly dilated in 6. Hypertrophy of the right ventricle, of more or less marked grade, was present in 41 of the 77 severe cases, and in 25 of the 96 cases of less marked stenosis. The right ventricle was dilated in 40 of the 77 severe eases and in 27 of the 96 slighter cases. The left ventricle was generally normal or small; rarely en larged by hypertrophy or dilatation. Pericarditis had been present in nearly one-third of all the cases. The peri cardium was universally adherent in 35 instances. Sudden death occurred in at least seven cases. A presystolic murmur is heard sometimes in the course of the disease in about three-fifths of all eases, and a thrill felt in about one-third or less, while a history of rheumatism may be traced in upward of 60 per cent. of all cases. Samways (lint. Med. Jour., Feb. 5, '98).
Prognosis.—As already stated, mitral stenosis is not incompatible with a toler able degree of health, and may not for years call attention to itself. Even after compensation has been impaired, great improvement may be repeatedly obtained by suitable treatment. On the whole, the disease may be said to be somewhat less favorable than is mitral insufficiency. Yet, of this, as of every cardiac lesion, it should be said that the prognosis de pends upon the peculiarities of the indi vidual case, which should be considered upon its own merits.
Treatment. — For treatment, see the article on DILATATION OF THE HEART and also GENERAL REMARKS at the end of this section.
Aortic Regurgitation.
Definition. — A lesion of the aortic valves allowing a reflux of blood into the left ventricle during diastole.
A patient with free aortic regurgita tion may for years lead an active life unconscious of his condition. In no other valvular disease is compensation, while it lasts, so perfect. If, however, the lesion develops abruptly, it will pro duce marked symptoms. For instance, when it is consequent upon the sudden rupture of a segment of the valve during violent physical exertion, or when the valve is perforated by the ulcers of malig nant endocarditis, the heart may be al most or completely overwhelmed by the sudden strain put upon it, the left ven tricle dilating and thus causing relative insufficiency of the mitral valve, engorge ment of the lungs, and an embarrassment of the whole circulatory apparatus, from which the patient can scarcely recover.
In some instances the first shock is successfully endured, and a slow develop ment of the reserve-power of the heart establishes compensation. This happier result was observed by the writer in the case of a Western miner in whom the aortic lesion developed over night.
Symptoms.—Where compensation has been perfect and is beginning to fail, the first symptoms may be cerebral, such as dizziness, flashes of light, and slight headache; there may also be faintness and palpitation on slight exertion. A patient seen by the writer had for his first symptom a sharp neuralgic pain in the lower jaw which developed while he was carrying a canoe on his back through the woods of Maine. Pain may be very prominent. It is usually prrecordial, but may extend into the neck and down the arms, particularly the left arm. Angina pectoris may occur, and in no form of valvular disease is sudden death more common than in this.
Compared with mitral lesions, there is less apt to be cyanosis, bronchitis, or anasarca; more apt to be head-symptoms and pallor. Embolism may occur, and slight febrile attacks are not uncommon, either due to recurrent endocarditis or in some instances to articular rheumatism. In this and in other valvular lesions there may be delirium toward the close of life.
It is also stated that there seems to be some connection between mental dis eases and cardiac lesions even when well compensated. With regard to this the writer has had no practical experience. It is usually said that the cardiac psy choses are apt to be of a melancholy character. Savage says: "With aortic or with both aortic and mitral disease, the symptoms may be either melancholic or maniacal; but I am inclined to think that, with simple aortic disease and with hypertrophy of the left ventricle, it is at least not uncommon to meet with acute mania and exaltation of ideas." Aortic regurgitation sometimes occa sions cerebral haemorrhage; and peri carditis sometimes complicates disease of the aortic valves whether stenosis or re gurgitation.