Remarks on some of the clinical features of tricuspid stenosis / by G. A. Gibson.

Date:
[1893?]
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on some of the clinical features of tricuspid stenosis / by G. A. Gibson. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    that the thought struck me, Is it possible that we can have in this case not only a mitral but also a tricuspid stenosis ? But I dismissed the idea as in the highest degree improbable, and referred the great propagation to the loudness and roughness of the mitral murmur. The result shows that in this I was mistaken, though unquestionably there were no other symptoms present but the excessive propagation of the murmur which could countenance the former idea.” In this case considerable stenosis of both mitral and tricuspid orifices was found on post-mortem examination. The result of this case was such as to lead L)r. Balfour to diagnose in a similar case combined mitral and tricuspid stenosis, but, as down to the time of the pulilication of the second edition of his work the patient was alive, tlie diagnosis was not absolutely confirmed. The results of such valuable experience seem to me abso- lutely conclusive with reference to the case of Marion E., in so far as concerns the diagnosis of tricuspid stenosis. But with a presystolic murmur of practically the same intensity at the apex as at tlie sternum it is impossible to avoid the conclusion that there was also in this patient an obstruction of the mitral orifice. T(j doulit this is to fly in the face of every principle of the physical diagnosis of cardiac valvular lesions, and the case was therefore assumed to be one of stenosis of both auriculo- ventricular orifices. No doubt another consideration tends to support the view that in this case there is a double lesion. If it be diagnosed as at any rate one of tricuspid stenosis, the extreme rarity of this lesion, apart from coincident mitral obstruction, is a strong argument, when unopposed by the facts of physical diagnosis, in favour of combined mitral and tricuspid obstruction. With reference to this very interesting case, one final remai'k must be made. It will be remembered that, with the sole exception of an attack of htsmoptysis on a former occasion when she was air inmate of the Eoyal Infirmary, her health has always been good. She has, in particular, never had a rheumatic symptom, unless the pains for which she presented herself in November are of this nature. It appears to me as in the highest degree probable that the valvular lesions are congenital. Two of the greatest authorities on cardiac disease.