1082 Acute Endocarditis. 



variable degree in whicli the heart muscle is involved, the 

 different localization of the inflammation and finally the pres- 

 ence or absence of a general infection which in itself may be 

 very variable in nature, produce symptoms which differ in 

 different cases. With respect to the last mentioned factor it 

 must be emphasized that in many cases the blood remains free 

 from microorganisms after the bacteria have been deposited 

 upon the valves, while more frequently bacteremia exists from 

 the beginning or develops later, in addition to the valvular 

 inflammation. 



The disease commences with more or less marked signs 

 of indisposition. In this respect particularly deviations are 

 possible according to nature and origin of the disease, only 

 languor, lassitude, slight fever and fatigue becoming manifest 

 in some animals, while in others extreme debility, complete 

 inappetence and high fever are observed, as they always occur 

 in septicemic diseases. Between these extremes there are many 

 transitions. 



The heart beat is usually increased or bounding and may 

 produce a tremor of the chest wall which can be noticed from 



Fig. 190. Sphygmograph of the Art. femoralis in a dog with ulcerating endocarditis 

 of the aortic valves. Pulse bounding and muoli accelerated. ( Time indicated in 0.2". ) 



a distance. The rate of the heart beats varies; while it is 

 increased by about one-half of the normal in light cases, it 

 rises in severe attacks in large animals to 4 to 5 times, in small 

 animals to 2 to 3 times the usual rate, and is frequently 

 arhythmic. The cardiac dullness is not altered at first, nor 

 in rapidly progressive cases through their entire course, but 

 in more prolonged cases, in which the heart is dilated, the area 

 of dullness is enlarged. The heart sounds may remain clear 

 for a long time, indeed, to the end, except that they may become 

 somewhat feeble and dulled, but in most cases they eventually, 

 become changed. Usually the two sounds run together into a 

 single humming or roaring noise ; at other times an endocardial 

 murmur is heard instead of the first or second heart sound or 

 in place of both, which is usually, soft, blowing or even has 

 a certain resonance to it and is heard in varying intensity 

 over different portions of the heart, just as in chronic endo- 



