: A System of Practical Medicine. By American Authors. Vol. 3 Diseases of the Respiratory Circulatory and Hæmatopoietic Systems by Pepper William Editor Starr Louis Editor - Medicine Practice

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above-mentioned cases that cardiac murmurs rarely necessitate a bad prognosis unless hypertrophy and dilatation coexist; but so soon as the signs of considerable dilatation and hypertrophy are present a great variety of complications are liable to occur.

In 1870, I had a patient sixty years of age with extensive aortic reflux, who had been under my observation eight years, during which time he had three attacks of pneumonia. There were no appreciable signs of cardiac dilatation in his case.

Walshe says: "The order of relative gravity, as estimated not only by their ultimate lethal tendency, but by the amount of complicated miseries they inflict, is--1, tricuspid regurgitation; 2, mitral obstruction and regurgitation; 3, aortic regurgitation; 4, pulmonic obstruction, 5, aortic obstruction."

The following are conditions which render the prognosis in each valvular lesion more or less unfavorable:

In aortic stenosis the prognosis is less grave than in any other valvular lesion. Life may be prolonged and good health enjoyed for many years. Yet it must be remembered that extensive aortic stenosis rarely exists without attendant regurgitation.

So long as the hypertrophy of the left ventricle compensates for the obstruction, the prognosis is good; but when the hypertrophied walls fail to overcome the obstruction, dilatation begins, and the ventricular systole becomes feeble and intermitting, and the arterial supply to the brain is so much diminished as to lead to cerebral anaemia.

If after sudden exertion or violent muscular effort there is interruption or great irregularity in the heart's action, sudden death may occur from a complete arrest of the ventricular systole.

Evidences of excessive hypertrophy and dilatation, the occurrence of syncope, signs of cerebral anaemia, attacks of vertigo, great muscular prostration, continued and marked paleness of the face, and irregularity of the pulse, render the prognosis exceedingly unfavorable in aortic stenosis.

If the presence of vegetations can be determined, there is danger from cerebral embolism.

When there are no evidences of alterations in the ventricular walls after an aortic obstructive murmur has existed for some time, it may be assumed that no vegetations exist on the valves, and that the murmur is not due to extensive aortic stenosis, and consequently is not dangerous to life.

When the mitral valves become involved, the combined lesions render the prognosis unfavorable.

Death may result from cerebral complications, pulmonary oedema, or cardiac degeneration.

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