Diseases of the chest and the principles of physical diagnosis . caliber. The mitral orifice consistsof a mere slit, of crescentic outline—buttonhole type. The tricuspid orifice is also con-tracted. {Specimen from the Philadelphia Hospital.) Pathological Physiology.—With the onset of the stenosis the wall ofthe right auricle hypertrophies as the result of the increased amount ofwork it has to perform. Owing to the increased strength of the rightauricle the auricular or presystolic wave is large and well marked. Mac-kenzie refers to a case in which the auricle had become so greatly hj^per-troph
Diseases of the chest and the principles of physical diagnosis . caliber. The mitral orifice consistsof a mere slit, of crescentic outline—buttonhole type. The tricuspid orifice is also con-tracted. {Specimen from the Philadelphia Hospital.) Pathological Physiology.—With the onset of the stenosis the wall ofthe right auricle hypertrophies as the result of the increased amount ofwork it has to perform. Owing to the increased strength of the rightauricle the auricular or presystolic wave is large and well marked. Mac-kenzie refers to a case in which the auricle had become so greatly hj^per-trophied that it sent back a large wave into the jugular vein, and with 750 DISEASES OF THE PERICARDIUM, HEART, AND AORTA such force that he was able to hear the valves in the jugular and sub-clavian veins close with a snap. Hypertrophy of the right auricle alsosends a wave back into the veins with such force that distention of theliver and pulsation of that organ is brought about. Later when theauricle becomes overdistended and paralyzed, the veins remain per-. FiG. 408.—Acute and chronic endocarditis of the aortic, mitral, and tricuspid upper portion of the auricles has been cut away. The three valvular orifices thusexposed show induration and contraction of their component tissues. The mitral valvein addition shows a large dark mass of vegetations of recent origin which almost com-pletely occlude its orifice. The endocardium and myocardium of both auricles are thick-ened. (Photograph by Dr. Alfred R. Allen.) ENDOCARDITIS 751 manently full and cease to pulsate. Damming back of the blood in theveins increases the pressure in these vessels; interferes with the circula-tion of the blood through the heart and lungs; produces cyanosis; andfinally may cause polycythemia. The slightest overstrain may aggravate the venous stasis and bringabout extreme dyspnea, cyanosis, edema and effusions into the serouscavities. These symptoms may pass off quickly when the patient isput
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