. The diseases of infancy and childhood : designed for the use of students and practitioners of medicine. pal character. The patients may eventually developsymptoms of serious cardiac insufficiency. The cases of chronicAaKiilar disease resulting from an attack of some infectious diseasemay leave the heart little compromised. It is true that upon examina-tion there is a cardiac murmur, but the cases reveal no Fig. 186.—Simple mitral ;dilatation of the left ventricle. Girl, agedsix years. 684 DISEASES OF THE CIRCULATORY SYSTEM They ha^-e what is called a healed
. The diseases of infancy and childhood : designed for the use of students and practitioners of medicine. pal character. The patients may eventually developsymptoms of serious cardiac insufficiency. The cases of chronicAaKiilar disease resulting from an attack of some infectious diseasemay leave the heart little compromised. It is true that upon examina-tion there is a cardiac murmur, but the cases reveal no Fig. 186.—Simple mitral ;dilatation of the left ventricle. Girl, agedsix years. 684 DISEASES OF THE CIRCULATORY SYSTEM They ha^-e what is called a healed endocarditis. They ina\-, how-ever, develop serious cardiac s>Tnptoms at the onset of an infectionof the intestine or other organs. The heart in these cases may becalled irritable. The patients do not develop inflammation of theendocardium or pericardium as do the rheumatic cases. On slightdisturbance of the intestines, such a heart, e\en when there is nofever, acts very much like an hypertrophied organ. There is an increasenot only of the frequency, but also of the force of the hearts Fig. 1S7. -Chronic cardiac disease; dilatation of the right and left ventricle,pulsation. Boy, aged six years. Epigastric The vessels are also affected, and there is a bounding, full pulse at theradial. As accompaniment of the infection there will be albumin andcasts in the urine. These symptoms subside and do not recur exceptat long intervals. In the intervals, with the exception of a valvularmurmur, there are absolutely no signs of cardiac disease. In children, a slight or marked valvular lesion which is apparentlyat a stand-still, gives certain symptoms which are significant of defectivecardiac action. On exertion the children complain of pain in the DISEASES OF THE HEART 685 side or the epigastrium. Examination will show httle change in thecardiac area. The valvular murmur is heard. Such hearts are alsoirritable. I have often found a distinct history of palpitation occurringat
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