Prognosis in valvular disease of the heart

John F. H. Broadbent
1909 Transactions of the Royal Academy of Medicine in Ireland  
THE subject of prognosis in heart disease is one of the iirst importance to both physician and patient. The latter will wish to know not merely whether he is in danger of sudden death, but what ate his prospects as to the future, and how best he may regulate his mode of ]ife, exercise, diet, &c., s~ as to give himse]f the best possible chance. The physician is required~ therefore, not merely to make ah accurate diagnosis of the nattlre of the ai~ection, but to forecast what eftect ir is likely
more » ... ftect ir is likely to have in shortening the patient's life and in limiting the sphere of his activity. To do this he must have a clear idea as to the relative danger attending the various valvular lesions and also some method of estimating the extent of the lesion. In 1884 my late father delivered before the Harveian Society the Harveian Lectures on "~' Prognosis in Valvular Diseasc of the Heart," in which he laid down certain ntles for guidance in prognosis, based on the structural changes in the heart and vascular system which take place a s a result of the lesion, pointing out how an approximate estimation of the extent of the lesion could be arrived at from the degree of structural change to which it had given rise. I had the privilege of working under him and with him for raany years, and of watching the course of many cases of heart: 44 Prognosis in Valvular Disease o] the Hea~~-t. disease, both in hospital and pdvate p~actice, and I have seen bis conclusions fully justified, and found them o~ inestimable value myself in attempting to Ÿ orecast the future in cases of valvu]ar disease: There ate, of course, many other points which must be taken lato consideration, such as the age and family history of the patient, the mtiology of the lesion, whether due to acute endocarditis o~ chronic degenerative change, the character of the mu~mur, and the degree to which it replaces the sound ir accompanies, &c. These will be dealt with seriatim in the discussion on the different valvular lesions. One is apt to overlook the lact that, on the establishment of a valvular lesion, nature does her best to remedy the defects in the circulation to which ir gives rise by every means in her power, and that the hypertrophy, and even dilatation in some instances, of the various cavities of the heart which we look upon as pathological ate really beneficial, and the only available methods of satisfactorily counte~acting the disturbing effects of the reflnx of obstruction to which the lesion has given rise. The one mistake which she makes is in the excessive formation of fibrous tissue thrown out in the 9 attempt at repair, which lates on may contraer to an inordinate extent and lead to disastrous results, more especial]y in the case of mitral stenosis. Ir is remarkabte also how the vascular system adapts itsdf to meet the different requirements of the .circulation in valvular lesions. Thus, in mitral of aortic stenosis we find the vessds, taking the radial artery as our guide, contracted down and small in proportion to the degree of narrowing of the valvular orifice ; ior it is obvious that ir the vesse]s remaŸ their normal size the attenuated stream of blood flowing into them could not maintain the pressure requisite for ah eiIicient circulation. In aortic incompetence, on the other hand, where we have a powerful hypertrophied ]eft ventricle throwing into the
doi:10.1007/bf03171908 fatcat:5l5yeqw2wbcjrjvf6s3lpykgby