1. Narrowing of the orifice between the left ventricle and the aorta is as a rule the result of arteriosclerosis.

2. The left ventricle has to overcome obstruction to circulation.

3. Aortic stenosis has no prominent symptoms.

2. Render the text using these sentences as an outline.

   1. Narrowing of the orifice is found as a rule in elderly people.

   2. Calcareous plates occlude the lumen of the aorta.

   3. Changes of cardiac murmurs.

   4. The pulse becomes slow and blood pressure low.

   5. Aortic stenosis has few symptoms.

Aortic insufficiency

Lesions of the aortic valve cusps which prevent them from perfectly closing the aortic orifice produce aortic insufficiency. In cases of this due to luetic aortitis, not only are the cusps injured, but the valve insuffi­ciency is made much worse by the weakening and spreading of the aortic orifice.

Because of the leak in the aortic valve during diastole some of the blood in the aorta, always under high pressure, hisses back into the left ventricle, which therefore must handle an increased volume of blood: both that which the left auricle normally delivers into it through the mitral orifice and that returning from the aorta. The left ventricle, therefore, dilates to accomodate this increased volume, hypertrophies in order to be able to expel it and does so with more than normal force, thus raising the systolic blood pressure. By another reflex also the cardiovascular system tends to, become accomodated: the peripheral arterioles become relaxed, thereby lowering the diastolic pressure considerably.

Of aortic insufficiency there are three types. The first is the endo- carditic, due usually to simple rheumatic endocarditis, which usually also injures the mitral valve. The second is the luetic, due to the extension of a syphilitic aortitis to the aortic valve cusps, deforming these; in addition it leads to weakening and, in consequence, enlargement of the ring sur­rounding the aortic orifice. Luetic aortic insufficiency is to be suspected in all patients with marked aortic insufficiency, but with normal mitral function. The third type is the arteriosclerotic, the arteriosclerosis of the aorta spreading to the aortic flaps (which really are folds of intima). Thin last type is the most serious of all since the arterial disease eventually involves the coronary arteries (which open from the aorta just behind th(* aortic cusps). An hypertrophied heart requires an increased supply of blood, and this its diseased arteries cannot efficiently supply. Arterio­sclerosis not only causes the valvular lesion but leads to decompensation. The same problem often arises in luetic aortic insufficiency, for although the aortitis seldom extends up the coronary arteries, yet luetic athero­matous plaques do narrow their orifices into the aorta.

The patient may complain of palpitation on exertion, of ringing in the ears, and perhaps of dizziness on sudden movements. Patients with aor­tic insufficiency usually have a characteristic pallor, described as "earthy color"; yet seldom are they anemic. If the trouble began early in life the whole precordium may bulge and pulsate with each heart beat. The heart is enlarged, occasionally huge, its apex displaced downwards, so that the apex beat may be in the sixth or seventh left interspace, in or just beyond the nipple line. The changes in blood pressures (high systolic and low dias­tolic) are almost characteristic.