Heart failure is often regarded as one of the important negative features of subacute bacterial endocarditis. Attention has been repeatedly directed to the absence of myocardial insufficiency in the disease. In this respect subacute bacterial endocarditis has been contrasted with rheumatic carditis, in which heart failure may be prominent in the clinical picture and may exist in a chronic and advanced form. However, it is generally admitted that heart failure may make its appearance during the late stages of the disease. Toxemia, a prominent factor in subacute bacterial endocarditis, has commonly been considered causal.
A short outline of the literature concerning the role of heart failure in subacute bacterial endocarditis is given in this paper, and the opinions on the character and extent of the anatomic changes in the myocardium in this disease are discussed. Observations in 40 cases of subacute endocarditis are presented, with special attention to evidence of