Studies in cardiac pathology . Malignant endocarditis may be primary or secondary; theright-sided valves are attacked oftener than in the simple vegetations tend to be more exuberant and friable, andmural involvement is commoner. Valvular rupture (chieflymitral and aortic) is sometimes preceded by aneurismal dilatationof the same, extending in the direction of greatest pressure. Ananeurism of the mitral valve generally involves the anterior flap.(See Fig. 14.) Rupture of the valves or chordae tendinese, es-pecially when the process is acute, is usually preceded by oldvalvular disea
Studies in cardiac pathology . Malignant endocarditis may be primary or secondary; theright-sided valves are attacked oftener than in the simple vegetations tend to be more exuberant and friable, andmural involvement is commoner. Valvular rupture (chieflymitral and aortic) is sometimes preceded by aneurismal dilatationof the same, extending in the direction of greatest pressure. Ananeurism of the mitral valve generally involves the anterior flap.(See Fig. 14.) Rupture of the valves or chordae tendinese, es-pecially when the process is acute, is usually preceded by oldvalvular disease. Myocarditis maj^ occur by extension of theinflammatory process. The infarcts of malignant endocarditis perhaps so rarely leadto suppuration on account of the low virulence of the organismsto which many cases owe their existence. Embolic manifestationsvary greatly in different cases. Sometimes they are very extensive, Brit. Med. Jour., Mar. 7, 1885, p. Fig. 4.—Acute Infective showing large thrombi formed on the ulcerated areas of the aortic verj small verruca in the of Valsalva, and some small mural thrombi between theeolumna; oarneic of the left ventricle. 10 STUDIES IN CARDIAC PATHOLOGY as in Hopers case of mitral stenosis, in which both femorals,the right internal iliac, the right renal, the superior mesenteric,and the left brachial arteries were occluded by emboli.^ The verrucose vegetations of endocarditis, which, as Hirsch-felder has pointed out, maj^ form within a few hours after damageto a valve, are in part the result of the action of the blood-streamupon the fibrinous exudation. In long-standing cases contractionof organizing fibrin doubtless plays a part in the production ofwartlike vegetations. Predisposition.—The more frequent involvement of the leftside of the heart has been explained by the fact that after birthblood-pressure is higher and oxygenation greater than on the
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