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Chronic mitral and tricuspid endocarditis

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BS, 21-year-old black woman. Philadelphia Hospital Autopsy. Volume 18, page 154. Physician: Dr. Hughes. Pathologist: Dr. McConnell. The woman had acute rheumatic fever 4 years previously and again 2 years later. Beginning with the first episode of rheumatic fever, she developed exertional dyspnea and dizziness. She was tachycardic (heart rate 110), and her heart was enlarged to percussion. A presystolic thrill was palpated within the apex, where a double mitral murmur was heard. Both second sounds were accentuated, especially the pulmonic. Death occurred from progressive congestive heart failure. Pathologic diagnosis: chronic mitral and tricuspid endocarditis; chronic pleurisy; right pleural effusion; congestion and edema of the right lung; bilateral pulmonary infarcts; diffuse nephritis. The heart weighed 340 gm. The mitral orifice barely admitted the tip of the index finger. The tricuspid orifice (the lowest on the plate) is small; leaflets thickened, and on free edges are numerous vegetations. On one leaflet, there is a vegetation that is 1 inch in height, extending directly into the opening. (Source: Norris GW. Studies in cardiac pathology. Philadelphia and London: WB Saunders Company, 1911. Photograph restored and edited by Dr. Douglas J Lanska.)