Diseases of the chest and the principles of physical diagnosis . Fig. 203.—^Mitral stenosis. This lesion generally occurs in early adult life, and resultsfrom rheumatic endocarditis. The illustration shows enormously thickened and contractedmitral curtains, thickened, shortened and adherent chordse tendineae, and as a result, afunnel-shaped mitral stenosis. The most characteristic physical signs of mitral obstruction are: a presystolic thrill ardmurmur at the apex, with a snappy first sound, and accentuation of the pulmonary secondsound. The pulse is small in volume and frequently irregular. T
Diseases of the chest and the principles of physical diagnosis . Fig. 203.—^Mitral stenosis. This lesion generally occurs in early adult life, and resultsfrom rheumatic endocarditis. The illustration shows enormously thickened and contractedmitral curtains, thickened, shortened and adherent chordse tendineae, and as a result, afunnel-shaped mitral stenosis. The most characteristic physical signs of mitral obstruction are: a presystolic thrill ardmurmur at the apex, with a snappy first sound, and accentuation of the pulmonary secondsound. The pulse is small in volume and frequently irregular. The heart enlarges towardthe right. r<^. Fig. 204.—Illustrating the direction of blood flow in mitral obstruction. 244 THE EXAMINATION OF CIRCULATORY SYSTEM f All these rules are subject to exceptions due to cardiac displacement,etc. Murmurs themselves are variable and often multiple and compU-cated bv pericardial or respiratory sounds. Occasionally murmurs are
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