Chronic Inflammation of the Heart's Lining.
Physical Signs. The impulse more perceptible and diffused than natural.
The dull sound upon percussion covers a space of from four to eight square inches.
There is a sawing, rasping, or filing sound. This sound may cover one or both beats of the heart. Sometimes these unnatural sounds are double; in which case, the first is caused by an obstruction to the natural flow of the blood forward; the second, by the regurgitation or retrograde flow of the blood from some defect in the valve, just as a pump valve may get out of order, and allow the water which has gone through to flow back.
Explanation. A variety of organic changes occur in the valves, which give rise to the murmurs. Inflammation of the lining membrane of the heart reaches the valves, causing puckering, thickening, vegetative, cartilaginous, bony and fat like degenerations, which obstruct the blood in its onward flow, or prevent a closure of the valves, and allow it to flow back; the former causing the first sound, the latter the second. If the unnatural noise be synchronous with the first beat of the heart, it implies disease in either set of the semi lunar valves, or an impossibility of closing the auriculo ventricular openings; if it accompany the second beat, it signifies that either set of the semi lunar valves maybe open.
A murmur attending the first beat of the heart must be caused by a current of blood from a ventricle; one attending a second sound, by a like necessity, is produced by a current into a ventricle.
Treatment. The same as that for pericarditis. It should be equally prompt and vigorous. It must not be forgotten that this disease leads to various organic diseases of the valves of a very grave character, and that such mischiefs can only be escaped by cutting the disease short in the very beginning.
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