A case of traumatic endocarditis / A. Herzfeld.

  • Herzfeld, Alfred Abraham.
Date:
1906
Catalogue details

Licence: In copyright

Credit: A case of traumatic endocarditis / A. Herzfeld. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    7/10 (page 5)
    time of the injury—this will exclude any acute ailment, nor did he have any increase of temperature after the injury. The injury to the heart and the endocarditis following it could not have been caused by anything else but the trauma, because immediately afterward the pre- viously apparently healthy heart showed the severe clin- ical affection described above. As the trauma did not cause the least injury to the wall of the thorax itself nor any visible injury of any kind, we must assume that we had to deal with a so-called contrecoup injury to the heart. One of the most striking features of my case was the enormous dilatation of the heart, but there was no tear in the heart muscle itself, no fluid could be detected in the pericardium by either Dr. Adler nor myself. The extent of the dilatation did not change very much dur- ing the entire two years, and the compensation of the heart muscle itself was never well established. Ebbinghaus4 claims that the acute dilatation of the heart muscle itself may cause a tear in the endocardium, even when there is absolutely no injury to the bony framework of the thorax, which, being elastic, yields, but the heart muscle not yielding, causes a contrecoup tear in the endocardium. In all cases where the heart muscle has been injured by blunt violence the valves are most frequently affected, and even a perfectly sound valve may be seriously injured or ruptured, as demon- strated by Bari6° in experiments on the cadaver and by cases published by Foster0 and Schmidt3. The left ventricle, valves and muscle are much more liable to injury than the right, but the rupture of the muscle seems to be more frequently met with on the right side. BarieV statistics of thirty-eight cases show injury to the aortic valve nineteen, mitral valve sixteen, and tricuspid valve three. Of all the valves the aortic is most frequently injured. The injuries to the mitral valve consist mostly in the tearing of the chordae tendi- neae or of the papillary muscles. The valve itself is rarely implicated. In Barie’s sixteen cases of mitral injury mentioned above an autopsy was made in fifteen cases and nine showed the tearing of the chordae tendi- neae, five the tearing of the papillary muscles, in one case both lesions were present, none, however, showed a tear in the valve itself. These injuries always cause an insufficiency of the valve. In my own case the mitral and 6. Foster: Medical Times and Gazette, 1873, vol. 11, p. 657.