ACUTE ENDOCARDITIS 87 



and insufficiency of the valves of the heart. The endocar- 

 dium in general is swollen, opaque, reddened somewhat, and 

 covered with a thin coagulum; small hemorrhagic foci are 

 found often in the subendocardial tissue, as well as between 

 the fibers of the heart muscle. 



(b) Endocarditis Ulcerosa.— This is the more severe form 

 of the condition, characterized by necrosis and ulceration 

 of the margins of the valves and other portions of the endo- 

 cardium. The ulcers are usually well defined, isolated and 

 vary considerably in size from a pea to several times larger. 

 They are covered with friable, discolored, necrotic masses. 

 These masses are often torn loose by the circulating blood 

 and are carried to the other organs, even to the heart itself, 

 forming metastatic abscesses. In dogs endocarditis verru- 

 cosa is very commonly found on postmortem and although 

 the lesions may be extensive no marked symptoms were 

 noted during life. The aortic or bicuspid valves are most 

 often affected. 



Symptoms. — The symptoms of acute endocarditis vary 

 considerably, depending to a great extent upon the cause, 

 and the nature and extent of the inflammatory process. 



The early symptoms are those of a greatly disturbed heart 

 action, which is at first palpitating and irregular; later the 

 beat is diffuse. The number of heart beats sometimes exceeds 

 that of the pulse (Frohner) . The heart beat is often so tumul- 

 tuous, especially in dogs, that the entire body is shaken and 

 can be observed some distance from the animal. 



The pulse is very rapid, intermittent, irregular, and in the 

 later stages becomes imperceptible. The frequency in dogs 

 will be 120-300, and in other animals even more rapid. The 

 heart muscle is at first normal, but soon becomes abnormal, 

 the sounds often blended to a single sound. Later, charac- 

 teristic endocardial bruits are heard, a blowing, stenotic 

 (systolic) noise occurring with the first heart sound, and at 

 times a prolonged rustling and vibrating sound occurs at 

 diastole. 



The temperature in the early stages is always high (103°- 

 105° F.), but in the dog it becomes normal or subnormal. 

 Cats have a high temperature, which remains high for a 



