. Medical diagnosis for the student and practitioner. rigin. Early signs ofinsufficiency. Definiteevidence. Terminalsymptoms. 688 MEDICAL DIAGNOSIS Usually due torheumatism. Associated frregurgitation equent. Duroziezsdisease. Rarely ornever recogniz-able at onset. Decompensa-tion longdelayed. Nearly or quite three-fourths of all cases follow acute rheumatic arthritis andthe remainder are almost entirely chargeable to other acute infections, chiefly ofthe youthful types. The primary arteriosclerotic form is rare; the congenitalcase, a clinical curiosity. Associations.—The stenotic lesion is se
. Medical diagnosis for the student and practitioner. rigin. Early signs ofinsufficiency. Definiteevidence. Terminalsymptoms. 688 MEDICAL DIAGNOSIS Usually due torheumatism. Associated frregurgitation equent. Duroziezsdisease. Rarely ornever recogniz-able at onset. Decompensa-tion longdelayed. Nearly or quite three-fourths of all cases follow acute rheumatic arthritis andthe remainder are almost entirely chargeable to other acute infections, chiefly ofthe youthful types. The primary arteriosclerotic form is rare; the congenitalcase, a clinical curiosity. Associations.—The stenotic lesion is seldom unassociated with regurgita-tion but, when advanced, usually overshadows and dominates its associate,more or less completely, in symptoms and physical signs alike. Seldom Isolated.—Rarely it occurs as an isolated lesion and then chieflyin persons bearing the stigmata of universal congenital asthenia,* in whomits manifestations are so peculiar as apparently to have mislead Duroziezinto describing it as a distinct ailment (Duroziezs disease).. Fig. 366.—Normal heart at the beginning of diastole. Delayed Manifestations.—Existing alone it is seldom or never recogniz-able in its true form during the attack of endocarditis which causes it and,aside from marked irregularities in rhythm, as an isolated lesion its decom-pensatory manifestations may not appear in any marked degree until thevalve has lost two-thirds of its normal caliber. Decided physical signs maybe manifest at a much earlier period. In almost every case an associated mitral regurgitation or, much less com-monly, an aortic leakage hastens the decompensatory stages. Persistently Progressive.—Its unremitting course once established, stenosiof the mitral valve almost invariably is slowly but persistently and inexorably * According to the authors personal observations. MITRAL STENOSIS 689 progressive though its victims may live one, two or even three decades after itsinception.* Anatomic Types.—Post-mortem,
Size: 1577px × 1584px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1922
