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Where persistent weariness is felt, and the least exertion bri...
Ulcers Case Xxix
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Decannulation After Cure Of Laryngeal Stenosis
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Length Of The Fast
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Acute Mild Endocarditis
Source: Disturbances Of The Heart
This inflammation of the endocardium is generally confined to the
region of the valves, and the valves most frequently so inflamed are
the mitral and aortic. There may be a slight inflammation or actual
ulceration and loss of tissue. Vegetations more or less constantly
occur on the inflamed surfaces, with more or less danger of
particles becoming loosened and moving free in the blood stream,
causing embolic obstruction in different parts of the body. There is
also more or less probability of serious adhesions or contractions
occurring from the healing of the ulcerated surfaces. The future
health and welfare of the valves depend on the fact that the
inflammation has healed without contractions or adhesions.
It is often difficult to decide when acute endocarditis has
developed; but with the knowledge that the endocardium often becomes
inflamed during almost any of the acute infections, the physician
should repeatedly examine the heart for murmurs, for muffled closure
of the valves, or for other evidences of endocarditis or myocarditis
during the acute infective process.
It has been shown positively that acute endocarditis is due to
micro-organisms, generally streptococci, staphylococci or
pneumococci, and, more frequently than once believed, gonococci. The
most frequent causes are acute rheumatic fever, diphtheria,
pneumonia, cerebrospinal meningitis, scarlet fever, erysipelas,
influenza, chorea, gonorrhea, sepsis and typhoid fever. It may also
follow a follicular tonsillitis or some infection of the mouth or
throat with or without arthritis. Tuberculosis may also occasionally
cause an endocarditis. Organisms may be found in a terminal simple
endocarditis due to a chronic disease, as tuberculosis or cancer;
such inflammations may have been caused by circulating toxins.
It will be noticed by the foregoing classification that the terms
"mild" and "malignant" endocarditis are used. The purpose is to
convey the fact that there may be no etiologic distinction between
the two forms, and it is impossible to decide clinically in the
beginning of an endocardial inflammation which form is present. In
the malignant form the infection is probably more serious or the
infective germs are more active, the ulcerations deeper, and the
likelihood of emboli and the seriousness of such embolic infarcts
more serious and more dangerous. The differences in inflammation in
the two cases is really one of degree, and the classification is
made to coincide with this probable fact. it is, of course,
clinically recognized that endocarditis following certain diseases,
especially rheumatism, is of the simple or mild type, while that
termed ulcerative endocarditis may occur apparently as a primary or
general infection, and the causative bacteria, as a rule, are
readily discovered in the blood. The Streptococcus viridans is one
of the most dangerous of these bacteria.
Next: Endocarditis A Secondary Affection