Diseases of the chest and the principles of physical diagnosis . ay occur as a result of an embolus. Having reviewed the general aspects of valvular diseases we will nowconsider the individual lesions more in detail. MITRAL INSUFFICIENCY Etiology.—This is one of the most common, if not the commonest,of cardiac lesions. A leakage at the mitral orifice may arise under thefollowing conditions: (1) The mitral insufficiency may be caused by an at- 718 DISEASES OF THE PERICARDIUM, HEART, AND AORTA tack of acute endocarditis occunins ii^ young; people. In the majority ofinstances the endocarditis has
Diseases of the chest and the principles of physical diagnosis . ay occur as a result of an embolus. Having reviewed the general aspects of valvular diseases we will nowconsider the individual lesions more in detail. MITRAL INSUFFICIENCY Etiology.—This is one of the most common, if not the commonest,of cardiac lesions. A leakage at the mitral orifice may arise under thefollowing conditions: (1) The mitral insufficiency may be caused by an at- 718 DISEASES OF THE PERICARDIUM, HEART, AND AORTA tack of acute endocarditis occunins ii^ young; people. In the majority ofinstances the endocarditis has resuhed from an attack of acute rheumaticfever, chorea or tonsilhtis. Although these conditions are the chiefoffenders, any one of the acute infectious diseases may produce the condi-tion. I have already emphasized the fact that in the so-called rheu-matic endocarditis it is the mitral valve which is principally- invo ved.(2) In a second group composed, for the most part, of individualswho have passed the fifth or sixth decade of life, the leakage is caused. Fig. 400.—Chronic mitral endocarditis. The mitral valve is thickened along its free edges,the leaflets are slightly retracted, and the chordce tendinece are distinctly shortened. by a chronic sclerosis of the valve. This is a part of a general arterio-sclerosis and occurs without an antecedent history of acute degrees of sclerosis of the mitral valve are encountered in nearlyall people of advanced years and just as in the case of the arteries, itis indicative of the general wear and tear of work. (3) Occurring witheven greater frequency is the leakage which occurs as the result ofrelative insufficiency. In this group the trouble is muscular and not EXDOCARDITIS 719 valvular. The valve itself is healthy but owing to lack of tonicity oras the result of acute or chronic myocarditis the left ventricle dilatesand in so doing stretches the mitral ring. Thus while the valve undernormal conditions is capab
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