84 DISEASES OF THE HEART 



Course. — ^The course is chronic. While an animal with 

 chronic endocarditis may live a long time and give efficient 

 service, especially in the stage of compensatory hypertrophy, 

 the disease is progressive and sooner or later leads to dis- 

 ability and death. Once the compensation is overcome the 

 patient develops the symptoms cited above and usually 

 rapidly declines. 



Differential Diagnosis. — In the absence of bruits a diagnosis 

 may not be possible. On the other hand if the bruit is well 

 developed, from its appearance at systole or diastole, the part 

 of the cardiac region over which it can be best heard, the 

 dyspnea on exercise, the increased area of cardiac dulness, 

 the venous pulse, tendency to attacks of vertigo, absence of 

 fever, etc., will furnish the clinician evidence on which to 

 rest a secure diagnosis. Suspected cases should be exercised 

 before examination. 



An exact location of the valvular lesion in chronic endo- 

 carditis is much more difficult and not as important as in 

 man. The following suggests the principal symptomato- 

 logical differences noted in the individual valvular and ostial 

 defects which result from this disease : 



Individual Valvular and Ostial Defects. — (a) Mitral 

 Insufficiency: Most common in the horse, dog and swine 

 (left heart). Systolic bruits very loud; accentuated second 

 heart tone. Pulse normal to weaker. Dyspnea, substernal 

 edema. 



(b) Mitral Stenosis : Diastolic bruits, weak pulse. 



(c) Tricuspid Insufficiency: Most common valvular 

 trouble of cattle (right heart). Systolic bruits, venous 

 pulse, cyanosis. 



(cZ) Tricuspid Stenosis: Diastolic bruits, venous pulse in 

 the ox. 



(e) Aortic Insufficiency: Diastolic bruits. Pulsation at 

 base of neck; peculiar swishing sound on auscultation. 

 Best heard near anterior border of fourth rib, approximately 

 eight inches from bottom of sternum. Sometimes fremitus 

 may be felt. Pulse strong, rapid, jerking ("water-hammer" 

 pulse). (P. celejT.) 



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