Etiology Pathology

If a chronic endocarditis has followed an acute condition, some

slight permanent papillomas or warty growths may he left from the

healed granulating or ulcerated surfaces. Sometimes these little

elevations on the valves become inflamed and then adhere together,

or adhere to the wall of the heart, and thus incapacitate a valve.

Sometimes these excrescences undergo partial fatty degeneration, or

may take on calcareous changes and thus stiffen a valve.

If the chronic inflammation is not superimposed on an acute

endocarditis there may be no cell infiltration and therefore no

softening, but there is a tendency to develop a fibrillated

structure, and a fibroid thickening of the endocardium occurs,

especially around the valves. This induration causes contraction and

narrowing of the orifices with shortening and thickening of the

chordae tendineae, and the valves imperfectly open, or no longer

close. Fatty degeneration may occur in the papillary growths with

necrotic changes, and this may lead to the formation of atheromatous

ulcers which may later become covered with lime deposits, and then a

hard calcareous ring may form. Fibrin readily deposits on this

calcareous substance and may form a permanent capping, or may slowly

disintegrate and allow fragments to fly off into the blood stream

and cause more or less serious embolic obstruction. If this chronic

endocarditis develops with a general arteriosclerosis, the wine

inflammation soon occurs in the aorta, and, following the

endarteritis in the aorta, atheromatous deposits may also occur

there. Chronic endocarditis of the walls of the heart, not in

immediate continuity with endocarditis of the valves, is perhaps not

liable to occur, except with myocarditis.

Etiology Etiology Treatment facebooktwittergoogle_plusredditpinterestlinkedinmail