Malignant Endocarditis Ulcerative Endocarditis

Categories: Uncategorized
Sources: Disturbances Of The Heart

Since we have learned that bacteria are probably at the bottom of

almost any endocarditis, the terms suggested under the

classification of endocarditis as "mild" and "malignant" really

represent a better understanding of this disease. They are not

separate entities, and a mild endocarditis may become an ulcerative

endocarditis with malignant symptoms. On the other hand, malignant

endocarditis may apparently develop de ovo. Still, if the cause is

carefully sought there will generally be found a source of

infection, a septic process somewhere, possibly a gonorrhea, a

septic tonsil or even a pyorrhea alveolaris. Septic uterine

disturbances have long been known to be a source of this disease.

Meningitis, pneumonia, diphtheria, typhoid fever and rarely

rheumatism may all cause this severe form of endocarditis.



Ulcerative endocarditis was first described by Kirkes in 1851, was

later shown to be a distinctive type of endocarditis by Charcot and

Virchow, and finally was thoroughly described by Osler in 1885.



Ulcerative endocarditis was for a long time believed to be

inevitably fatal; it is now known that a small proportion of

patients with this disease recover. Children occasionally suffer

from it, but it is generally a disease of middle adult life. Chorea

may bear an apparent causal relation to it in rare instances.



Ulcerative endocarditis may develop on a mild endocarditis, with

disintegration of tissue and deep points of erosion, and there may

be little pockets of pus or little abscesses in the muscle tissue.

If such a process advances far, of course the prognosis is

absolutely dire. If the ulcerations, though formed, soon begin to

heal, especially in rheumatism, the prognosis may be good, as far as

the immediate future is concerned. If the process becomes septic, or

if there is a serious septic reason for the endocarditis, the

outlook is hopeless. This form of endocarditis is generally

accompanied by a bacteremia, and the causative germs may be

recovered from the blood. One of the most frequent is the

Streptococcus viridans.