SUBACUTE BACTERIAL ENDOCARDITIS

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Abstract
One of the most striking features of the clinical picture of subacute bacterial (Streptococcus viridans) endocarditis is the frequent occurrence of the disease as a terminal condition in patients suffering from rheumatic endocarditis with chronic valvular deformity. A further point noted is that this infection rarely attacks mitral valves which on clinical examination show evidence of marked stenosis. Clawson,1for example, notes among the characteristic pathologic changes "large and villous vegetations on leaflets otherwise normal or thickened from previous inflammation and involvement of the mural endocardium." Levine2recently stated that "although mitral stenosis is the most common type of rheumatic valve disease, yet, bacterial endocarditis more frequently develops in patients who have had aortic regurgitation than in those who have had mitral stenosis," and further, that "it is those patients who either have aortic insufficiency or who have a mitral systolic murmur without evidence of mitral stenosis who

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