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Source: Disturbances Of The Heart
It is not easy to decide just whew all acute endocarditis has
entirely subsided and a chronic, slow-going inflammation is
substituted. It would perhaps be better to consider a slow-going
inflammatory process subsequent to acute endocarditis as a subacute
endocarditis; and an infective process may persist in the
endocardium, especially in the region of the valves, for many weeks
or perhaps months, with some fever, occasional chills, gradually
increasing valvular lesions and more or less general debility and
systemic symptoms. Such a subacute endocarditis may develop
insidiously on a previously presumably healed endocardial lesion and
cause symptoms which would not be associated with the heart, if an
examination were not made. Sometimes such a slow-going inflammatory
process will be associated with irregular and intangible chest
pains, with some cough or with many symptoms referred to the
stomach, so that the stomach may be considered the organ which is at
fault. There may be dizziness, headache, feelings of faintness,
sleeplessness, progressive debility and a persistent cough, with
some bronchial irritation and with occasional expectoration of
streaks of blood, which may cause the diagnosis of incipient
tuberculosis to be made. The need of a careful general examination
must be emphasized again before a decision is made as to what ails
the patient, or before cough mixtures are given unnecessarily,
quinin is prescribed for supposed malarial chills, or various diets
and digestants are recommended for a supposed gastric disturbance.
The term "chronic endocarditis" should be reserved for a slowly
developing sclerosis of the vavles. This may occur in a previous
rheumatic heart and in a heart which has suffered endocarditis and
has valvular lesions, or it may occur from valvular strain or heart
strain from various causes; it is typically a part of the
arteriosclerotic process of age, and is then mostly manifested at
the aortic valve.