82 DISEASES OF THE' HEART 



Secondarily acute endocarditis may occur as a symptom 

 of various infectious diseases (erysipelas of swine, influenza 

 of the horse, articular rheumatism of cattle). Endocarditis 

 the result of refrigeration, traumatism or from a spreading 

 of the inflammation of pericarditis or myocarditis is rare. 



Pathologically two forms of acute endocarditis are dis- 

 tinguished : (a) Verrucous, (6) ulcerous. These forms, how- 

 ever, are frequently combined. 



The verrucous form leads to organilzed exudate forming 

 on the margins of the valves, so-called vegetation, which leads 

 to thickening, distortion and adhesions, rendering the valve 

 ineflicient. The ulcerous endocarditis is a necrotic inflam- 

 mation of the endocardium with the development of pea- to 

 hickory-nut-sized ulcers. These are usually the result of 

 metastasis (lungs, kidneys). 



Symptoms. — ^The symptoms are heart palpitation and very 

 rapid, weak, often imperceptible, irregular, intermittent 

 pulse (horses 80 to 160). In rare instances the heart beat 

 is twice as fast as the pulse. There is dyspnea and high 

 fever (104° to 105° F.) Characteristic of the condition 

 are the systolic or diastohc bruits which occur, depending 

 upon which valves or openings are involved. When of 

 metastatic origin there may be brain (apoplexy), lung 

 (asphyxia), kidney (hematuria), or limb (lameness) symp- 

 toms. 



The course is either peracute causing death in a few 

 hours, or acute ending fatally in a few weeks; or more rarely 

 the course is chronic, leading to chronic valvular disease of 

 the heart. 



Differential Diagnosis. — ^The condition may be confused 

 with a number of acute disorders such as pulmonary edema, 

 pneumonia (dyspnea), septicemia and puerperal fever. If 

 the characteristic bruits are absent a diagnosis may be 

 impossible. 



Treatment. — Consists in quiet and cold applications to 

 the chest. Ulcerous endocarditis is usually incurable. 

 The verrucous form, however, is more benign. Recom- 

 mendable is digitalis (3iv) followed by strophanthus (Sj). 

 Heart weakness may best be combated by subcutaneous 



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