Diseases of the chest and the principles of physical diagnosis . aortic valve is theseat of the disease the vegetations have a tendency to extend down overthe endocardium and over the ventricular aspect of the aortic flap of themitral valve. Occasionally an aneurism of the valve leaflets may develop. Cerebral embolism, uremia, pneumonia and progressive anemia arethe common terminations. Symptoms.—-The onset is often insidious and without definite symp-toms. Very often, however, the initial symptoms are definitely referredto the heart, as for instance, shortness of breath on exertion, palpitati
Diseases of the chest and the principles of physical diagnosis . aortic valve is theseat of the disease the vegetations have a tendency to extend down overthe endocardium and over the ventricular aspect of the aortic flap of themitral valve. Occasionally an aneurism of the valve leaflets may develop. Cerebral embolism, uremia, pneumonia and progressive anemia arethe common terminations. Symptoms.—-The onset is often insidious and without definite symp-toms. Very often, however, the initial symptoms are definitely referredto the heart, as for instance, shortness of breath on exertion, palpitation,and cough which is sometimes attended with blood-streaked sputum. Fever is present in all cases (Fig. 398). It is often slight but in themajority of cases is high and intermittent in the late stages of the disease. 708 DISEASES OF THE PERICARDIUM, HEART, AND AORTA If splenic infarcts occur, the fever is apt to be high and and sweating may occur in association with the fever. Loss ofweight and extreme weakness take place in most Fig. 397.—Subacute infective endocarditis. Showing large thrombotic masses almostcompletely occluding the aortic orifice. There is marked left ventricular hypertrophy,and sclerotic patches are seen on the aorta above the sinus of Valsalva. Precordial pain or a sense of oppression in the chest is often in the joints is not uncommon and may be associated with slighttransitory swellings. A purpuric eruption may be present also. Libmanhas called attention to an important diagnostic sign, namely, tenderness ENDOCARDITIS 709 over the lower part of the sternum. The hghtest tap with the percussingfinger may cause marked pain. An important diagnostic feature is the presence of small, painfulerythematous nodules in the skin of the hands and feet. These cutaneousnodes rarely occur except in this form of endocarditis and are consideredby Osier as being pathognomonic. Petechiae in the skin and conjunc-tival mucous membran
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