DISEASE OF THE SEMILUNAR VALVES. 



361 



We have said above, that the two forms of valvular derangement 

 usually coexist ; as, however, insufficience soon predominates over ste- 

 nosis, we find a gradual transition from simple to the most intense ex 

 centric hypertrophy taking place in the left ventricle. 



SYMPTOMS AND COTJKSE. The ultimate effect both of stenosis and 

 of insufficience of the aortic valves must always be a retardation of 

 the circulation ; the bluod returns to the lung with diminished fre- 

 quence, and hence assumes a more venous character. (Of course, with 

 every systole, an abnormally small amount of blood is discharged from 

 the ventricle, or a portion of it flows back again during diastole.) The 

 consequences are, that the aorta and its branches are inadequately 

 filled, while, on the other hand, the pulmonary vein is gorged with 

 blood, which is prevented from flowing away into the left auricle, 

 already almost full. Thus the entire pulmonary system becomes over- 

 loaded; but, being incapable of containing the whole of the blood 

 which should properly fill the aorta, the remainder gradually accumu- 

 lates in the veins of the aortic system, and gives rise to cyanosis, 

 dropsy, etc. 



As a rule, however, nothing of this kind takes place, until after the 

 lapse of considerable time ; inasmuch as simultaneous hypertrophy of 

 the left ventricle has the opposite effect, and neutralizes the baneful 

 influence of the defective valves. While the latter tends to retard the 

 circulation of the blood, and to render it venous, hypertrophy accel- 

 erates its course and makes it arterial. While valvular deformity 

 causes decrease of the contents of the aorta, hypertrophy renders the 

 aorta fuller ; while deficience of the valves hinders the outflow from 

 the pulmonary veins, and lets the lesser circulation overcharge itself 

 with blood, hypertrophy facilitates such outflow, and relieves the pres- 

 sure upon the pulmonary system. 



By keeping these facts in view, it is easy to understand how it 

 happens that persons with extreme deficience of the valves of the aorta 

 enjoy comparatively good health, if only there be a compensatory 

 hypertrophy of the left ventricle ; and, indeed, such persons are fre- 

 quently not even short of breath, a symptom never missed in cases of 

 valvular disease of the mitral.* 



There may be some palpitation of the heart, but it is not constant. 

 It is very remarkable, too, that the patients complain so little of jarring 

 ot the thorax. Sometimes attacks of pain in the chest and left arm 

 occur, which we shall describe more closely in the chapter upon angina 

 pectons. 



* A huntsman in Greifewald, who suffered from extensive stenosis and insufficience, 

 and immense excentric hypertrophy of the left ventricle, performed all the manreu- 

 vres and forced marches of the army without difficulty. 



