Mitral regurgitation uncomplicated by any other valvular lesion gives rise to very little disturbance of the systemic or capillary circulation. It is more often fully compensated for than any other valvular lesion. The changes which lead to it are of slow growth and their tendency is to remain stationary. Patients with a moderate regurgitation at the mitral orifice suffer very little except during or after violent physical exercise, and, were it not for the slight dizziness which attends it, it would pass unnoticed. As long as the compensatory hypertrophy of the right ventricle is sufficient to overcome the obstruction to the pulmonary circulation, patients with this form of heart disease may not suffer from dyspnoea even after violent physical exercise. As regards the duration of life, the prognosis in mitral regurgitation is good. When, however, mitral stenosis and regurgitation coexist, the liability to sudden pulmonary complications becomes so great that a very guarded prognosis must be given; and it must be remembered that combined reflux and stenosis at the mitral orifice is a frequent combination.
In very many instances it is unnecessary to tell a patient with mitral reflux that he has an incurable heart disease, for with no other valvular lesion the individual may live to advanced life. But when it is combined with mitral stenosis it must be regarded as a very serious form of valvular lesion. As soon as symptoms occur that show failure of the right heart, the prognosis becomes unfavorable. Oedema of the extremities or fluid in any of the serous cavities, cyanosis, dyspnoea, and hæmoptysis, are indications of such failure.
Death may result from general anasarca, from serous effusions into the pleuræ, peritoneum, or pericardium, from pulmonary oedema and congestion, or from heart-insufficiency.
Extensive obstruction or regurgitation at the pulmonic orifice would necessarily lead to serious results, but there are no reliable data upon which the prognosis can be based.
The prognosis in tricuspid obstruction and regurgitation, when associated with mitral disease, is very grave; but it is not as bad as when it results from chronic bronchitis and pulmonary emphysema.
When in any case jugular and epigastric pulsation are marked, the changes in the various organs of the body already referred to rapidly ensue. Walshe says that "tricuspid regurgitation is the worst of all valvular lesions." Patients with tricuspid reflux are in extreme danger from intercurrent attacks of acute pulmonary hyperæmia.
Tricuspid disease, of all valvular lesions, leads most rapidly to cyanosis and dropsy.
TREATMENT.—The treatment of aortic stenosis and of aortic regurgitation may be summed up under three heads—viz. rest, diet, and regimen.
Rest is most important; it must be mental as well as physical; the appetite, emotions, and passions must be kept under perfect control: these indications are best maintained by a sedentary country life. Straining, especially when the hands are above the head, should be carefully avoided.
The stomach also must have all the rest compatible with the most perfect nutrition; it is frequently a difficult matter to combine both indications, for it should be remembered that the more perfectly the nutritive processes are maintained the longer will the cardiac muscle resist degeneration. Sugar, sweet vegetables, and animal fat must be sparingly indulged in. The food should consist of nitrogenous, albuminoid material, and should be taken in quantities that do not disturb the heart's action.