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Acute Mild Endocarditis

Categories: Uncategorized
Sources: 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.