Bacterial endocarditis with special reference to the cardiac irregularities: A clinical and pathological study of 191 cases

Abstract

1. 1. The literature is reviewed with reference to the cardiac irregularities in the course of bacterial endocarditis, rheumatic heart disease, and rheumatic fever. 2. 2. A study of 192 cases of bacterial endocarditis, with electrocardiographic studies in 67 cases, revealed 4 cases of auricular fibrillation, 2 of auricular flutter, 9 of heart-block, 2 of prolonged QRS interval, 1 of prolonged Q-T interval, 1 of left bundle-branch block, 9 of gallop rhythm, 15 of extrasystoles, 21 of left axis deviation and 6 of right axis deviation. 3. 3. Prolongation of the P-R interval occurs more commonly in the cases of bacterial endocarditis with involvement of the aortic valves alone, or in combination, than in cases of mitral involvement. 4. 4. Disturbances in conduction time, particularly intraventricular block and bundle-branch block, are far less common in bacterial endocarditis than in rheumatic heart disease. The same is true of gallop rhythm and premature beats. 5. 5. A statistical study, including all other reported cases, leads one to conclude that auricular fibrillation and auricular flutter are rare in the course of bacterial endocarditis. 6. 6. The occurrence of auricular fibrillation and flutter in the course of bacterial endocarditis appears to be related to the functional integrity of the myocardium rather than to any grade of mitral stenosis in itself.