Mitral insufficiency or incompetency.—­This is the most common valvular disease.  The segments of the valve may be shortened and deformed.  There is often stenosis (narrowing) caused by this deformity.  The effects are regurgitation, flowing back of blood from the left ventricle into the left auricle, which is also receiving blood from the lungs, causing dilatation of the auricle and its enlargement to expel the extra blood; dilatation and other enlargement of the left ventricle occurs on account of the large quantity of blood forced in by the auricle; obstruction to flow of blood from pulmonary veins due to extra blood in left auricle, hence dilatation and enlargement of right ventricle which forces blood through the lungs; dilatation and enlargement of right auricle.

Symptoms.—­If compensation is slightly disturbed we have blueness (cyanosis), clubbing of the fingers, hard breathing on exertion, and attacks of bronchitis and bleeding from the lungs.  If compensation is seriously disturbed we are likely to have the blueness (cyanosis) more marked, heart beat feeble and irregular, constant hard breathing, with cough and water or bloody sputum, dropsy in the feet first and going up and involving the abdomen and chest cavities.

Mitral stenosis.—­This is the narrowing of the valve opening.  It is most common in young persons, chiefly females.  The narrowing of the valve opening may be due to thickening or hardening of the valve segments, adhesion of their edges, thickening and contraction of the tendinous cords of the valve ring.

Symptoms.—­Similar to mitral insufficiency, but they develop slower and those symptoms of venous congestion of the lungs, liver, etc., are more marked; bleeding from the lungs is more common.

[344 Mothers’ remedies]

Tricuspid (valve) insufficiency.—­Cause.—­Usually due to dilatation of the right ventricle in mitral disease or with lung emphysema or other obstruction to the lungs’ circulation.

Tricuspid stenosis (narrowing).—­Rare except in cases from the time of birth.

Recovery from the valvular disease, depends upon the degree of compensation maintained and is best when this is acquired spontaneously.  This is to be judged by the heart action.  The prognosis is poor in children.  It is better in women than in men.

Treatment (a) While Compensated.—­Medicine is not necessary at this period.  The patient should lead a quiet, regulated, orderly life, free from excitement and worry; and the risk of certain death makes it necessary that those suffering from a disease of the aorta should be especially warned against over-exertion and hurry.  An ordinary healthy diet in moderate quantities should be taken, tobacco and stimulants not allowed at all.

The feelings of the patient must control the amount of exercise; so long as no heart distress or palpitation follows, moderate exercise will be of great help.  A daily bath is good.  No hot baths should be taken and a Turkish bath absolutely prohibited.  For the full-blooded, fleshy patient an occasional dose of salts should be taken.  Patients with a valvular trouble should not go into any very high altitudes; over-exertion, mental worry and poor digestion are harmful.