. Medical diagnosis for the student and practitioner. suddenly-the relatives should understand the possibility of a dramatically tragic exitus. AORTIC STENOSIS Etiology.—True aortic stenosis is a relatively uncommon lesion, affectingthe adult male almost exclusively, and, as an isolated lesion, constitutes a clinical46 722 MEDICAL DIAGNOSIS rarity. In the greater number of cases it is associated with a more or lessfree regurgitation.* As stated, to a large degree its causes are identical with those of the aorticregurgitations originating after the age of thirty, but it occurs also as a resulto
. Medical diagnosis for the student and practitioner. suddenly-the relatives should understand the possibility of a dramatically tragic exitus. AORTIC STENOSIS Etiology.—True aortic stenosis is a relatively uncommon lesion, affectingthe adult male almost exclusively, and, as an isolated lesion, constitutes a clinical46 722 MEDICAL DIAGNOSIS rarity. In the greater number of cases it is associated with a more or lessfree regurgitation.* As stated, to a large degree its causes are identical with those of the aorticregurgitations originating after the age of thirty, but it occurs also as a resultof acute vegetative endocarditis. It is essentially a lesion of the adult andof advanced age, of lues and of sclerosis, rather than one of the juvenileinfectious type as formerly supposed. As the result of chronic inflammation,adhesion and calcareous deposit, the aortic valves become fused into a moreor less pouch-like membrane, projected into the aortic lumen and possessinga central circular or slit-like opening. The margins of the opening may be. Fig. 392.—Normal heart in systole. such as will permit a small valvular excursion or it may be merely a rigiddiaphragm with a central aperture which, in extreme cases, may barely admita knitting needle, post-mortem.^ Physical Signs and Symptoms.—As might be expected, the signs areextremely frank and definite in advanced cases. * Save as it constitutes a general rule subject to exceptions, the authors personal expe-rience has not confirmed the perfectly reasonable and logical statements of Bamberger,Romberg, D. Gerhardt and others that mild grades of stenosis are associated with regurgi-tation and the extreme grades are not. In several of his cases representing the maximaldegrees of obstruction the regurgitation has been plainly manifest. This in fact was thecase in the most extreme aortic stenosis which he has seen at autopsy. t Its marked predominance in the male strongly suggests that lues is a more potentfactor than we have b
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