Studies in cardiac pathology . The marks of wear and tear upon the left-sided valves,and upon the whole arterial system, in this form of valvulardisease are very pronounced. The incessant pounding of thehypertrophic ventricle, the high systolic and low diastolic pressure,produce a very intermittent blood-supply, which of course affectsthe coronary arteries as well as those of the whole arterial one-third or one-fourth of the systolic output regurgitates,marked hypertrophy and dilatation will of course occur; but ifthe aortic lesion is slight, so that only a few cubic centimeters ofbl
Studies in cardiac pathology . The marks of wear and tear upon the left-sided valves,and upon the whole arterial system, in this form of valvulardisease are very pronounced. The incessant pounding of thehypertrophic ventricle, the high systolic and low diastolic pressure,produce a very intermittent blood-supply, which of course affectsthe coronary arteries as well as those of the whole arterial one-third or one-fourth of the systolic output regurgitates,marked hypertrophy and dilatation will of course occur; but ifthe aortic lesion is slight, so that only a few cubic centimeters ofblood flow backward, although a diastohc murmur may be heard,yet enlargement of the heart may not be sufficient to be clinicallydemonstrable (Krehl). The experiments of Henderson, Stewart/ and Moritz indicatethat much less blood regurgitates in aortic insufficiency than has Jacobi: New York Med. Jour., Aug. 9, 1902. - Zesas: Fortschritte in. d. Medizin, 1910, xxviii, p. 649. Henderson: Archives of Internal Medicine, Jan., Iir;. 10,—Aortic f>, Seen from Above. The leaflfits are fused together, thickened, and indurated. Tliey are covered witli small vegetations. 62 STUDIES IN CARDIAC PATHOLOGY hitherto been supposed. This is owing to an increased tonicitywhich the left ventricle assumes. The marked fluctuations ofblood-pressure which occur in these cases seem to be due to a reflexlowering of the diastolic pressure. This is borne out by the well-known clinical fact that diastolic pressure often ranges between40 and 60 mm. Hg, even where compensation is fairly well main-tained, while the systolic pressure is often as high as 180 amount of regurgitation depends upon the severity of thelesion and the efficiency of compensation in the myocardium,especially of the left ventricle and of the left auricle. Until quite recently it was generally believed that aorticinsufficiency was due to the same causes as those which producean obstruction or sclerotic change.
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