. Medical diagnosis for the student and practitioner. 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 th
. Medical diagnosis for the student and practitioner. 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, the disease presents two distinct types,\\z.\ First, the common button-hole mitral in which the cusps appear short, 11thick and adherent, and by reason of slowly progressive chronic inflammationand calcareous deposit, often form a solid mass surrounding the slit-like Fig. 367.—Graphic representation of three varieties of the murmur of mitral obstruc-tion. Heart at moment of auricular contraction immediately before systole (presystole);mitral obstruction evident; aortic and pulmonary valves closed;-tricuspid freely opened;right auricle nearly empty; right ventricle filled; left auricle but partly emptied; left ventriclebarely half full. Result.—Presystolic or diastolic murmur, dilatation of left auricle, conges-tion of lungs, consecutive enlargement of right heart, mv. Mitral valve, tv. Tricuspidvalve, av. Aortic valve, pv. Pulmonary valve. LA. Left auricle. RA. Right Left ventricle. RV. Right ventricle. Vena cava superior. Vena cavainferior. Pulmonary veins. Pulmonary artery. AO. Aorta. opening. Second, the funnel form which, resulting from less violent and The funneldestructive inflammation and less marked degenerative processes, shows adhe-sions of the
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1922
