Diseases of the chest and the principles of physical diagnosis . lythickened and contracted, showing at the right junction slight calcification; the whole pre-senting the appearance of the funnel-shaped buttonhole mitral. The chordae tendineaeare enormously thickened, retracted and adherent, and are attached to papillary muscleswhich are much elongated and have sclerotic tips. The fibrosis of the anterior mitralleaflet extends forward along the septum, below the bases of the aortic valves, producinga thickening which extends transversely through the bundle of His. The ventricularcaty is enlarg
Diseases of the chest and the principles of physical diagnosis . lythickened and contracted, showing at the right junction slight calcification; the whole pre-senting the appearance of the funnel-shaped buttonhole mitral. The chordae tendineaeare enormously thickened, retracted and adherent, and are attached to papillary muscleswhich are much elongated and have sclerotic tips. The fibrosis of the anterior mitralleaflet extends forward along the septum, below the bases of the aortic valves, producinga thickening which extends transversely through the bundle of His. The ventricularcaty is enlarged. Owing to the close proximity of the mitral valve to the auriculo-ventricu-lar bundle this specialized muscle often becomes the site of degenerativechanges. As a result, heart block, auricular fibrillation or flutter maydevelop. ENDOCARDITIS 727 There is some difference of opinion as to whether pure stenosis withoutinsufficiency ever occuis. In view of the character of the lesion it caneasily be understood, however, that some leakage is inevitable in many. Fig. 403.—Ball thrombus in the left auricle. A large, dark, ball-shaped thrombus liesfree in the left auricular cavity. Numerous smaller mural thrombi are seen enmeshed inthe columnse carneae and chordae tendinese. The left ventricular waU, which is elsewherehypertrophied, is noticeably thinned near the apex. (Photograph by Dr. Alfred R. Allen.) of the cases, although the clinical evidence of this may be masked by themore pronounced signs of the stenosis. Although there is usually some evidence of hj^pertrophy of the leftventricle it is not apt to be marked unless a considerable degree of in- 728 DISEASES OF THE PERICARDIUM, HEART, AND AORTA sufficiency is present also. The chamber which bears the brunt of theattack is the left auricle which may become enormously pressure in the pulmonary circulation leads to pulmonarycongestion and finally to hypertrophy and dilatation of the right ,
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1920
