Diseases of the chest and the principles of physical diagnosis . Fig. 393.^Acute infective mitral and mural endocarditis. The mitral valve is coveredwith large vegetations. Several of the chordae tendineas have been destroyed by ulcera-tion, only short unattached stumps Vegetations are alio seen on the muralendocardium. {Specimen from the Pennsylvania Hospital.) One of the most striking features of malignant endocarditis is theoccurrence of an embolism. This is not surprising when we recall thesoft, friable nature of the valvular vegetations. As the lesion progressesand necrosis se
Diseases of the chest and the principles of physical diagnosis . Fig. 393.^Acute infective mitral and mural endocarditis. The mitral valve is coveredwith large vegetations. Several of the chordae tendineas have been destroyed by ulcera-tion, only short unattached stumps Vegetations are alio seen on the muralendocardium. {Specimen from the Pennsylvania Hospital.) One of the most striking features of malignant endocarditis is theoccurrence of an embolism. This is not surprising when we recall thesoft, friable nature of the valvular vegetations. As the lesion progressesand necrosis sets in small pieces are whipped off bj* the blood currentand carried to some distant point. The viscera most commonly involvedare the spleen, kidneys and brain, but no portion of the body is exempt. 702 DISEASES OF THE PERICARDIUM, HEART, AND AORTA Occasionally mycotic aneurisms involving the larger vessels have theirorigin in this wav. If the valves in the right heart are involved there. Fig. 394.—Acute infective endocarditis. Showing extensive ulceration of the aorticvalves. About the center of the aortic orifice a match-stick projecting frona a thromboticmass indicates the course of the perforation in the aortic leaflet. {Specimen from the Phila-delphia Hospital.) may be infarcts in the lungs. Owing to the infective nature of the embolithe resulting infarcts commonly terminate in abscess some instances the embolic phenomena are absent. ENDOCARDITIS 703 Symptoms.—The clinical features of septic endocarditis do not lendthemselves readily to description. In some instances the true nature ofthe trouble can be surmised without much difficulty, but in a very con-siderable proportion of cases the endocardial lesion is masked by theprimary disease, such as puerperal sepsis, pneumonia, etc. It may be questioned whether it is worth while to consider the pro-tean aspects of this infection under diseases of the heart, since the mani-
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