. A practical treatise on medical diagnosis for students and physicians . tiated. The Mitral Valve Sound. The sound produced by closure of the mitralvalve is created opposite the third interspace one inch to the left of thesternum. It is transmitted to the surface of the chest by the thick leftventricle, and hence is heard loudest where that is nearest the chest,namely, at the apex—the mitral area. The Tricuspid Valve Sound. The sound produced by the closure ofthe tricuspid valve is transmitted by the right ventricle, and is heardloudest over the lower portion of the sternum—the tricuspid area
. A practical treatise on medical diagnosis for students and physicians . tiated. The Mitral Valve Sound. The sound produced by closure of the mitralvalve is created opposite the third interspace one inch to the left of thesternum. It is transmitted to the surface of the chest by the thick leftventricle, and hence is heard loudest where that is nearest the chest,namely, at the apex—the mitral area. The Tricuspid Valve Sound. The sound produced by the closure ofthe tricuspid valve is transmitted by the right ventricle, and is heardloudest over the lower portion of the sternum—the tricuspid area. The Diastolic or Second Sounds. Two sounds are created. The valvesat which they are produced are also in close proximity. To distinguishthe two sounds it is necessary to auscult over areas into which they aretransmitted. They may often, especially in diseased conditions, be dis-tinguished by their slight difference in time. In apparent health theaortic sound sometimes precedes the pulmonic by a fraction of a second,but this can scarcely be appreciated The valve-areas: 1, mitral area; 2, tricuspid area; 3, aortic area; 4, pulmonary area. The Aortic Valve Sound. The sound produced by the closure of theaortic valve is heard loudest at the second costal cartilage on the right,because the aorta which conducts the sound is nearest the surface of thechest at this point—the aortic area. This cartilage is known as theaortic cartilage. Cabot shows that it is heard loudest to the left. The Pulmonary Valve Sound. The sound produced by the closure ofthe pulmonary valve is conducted to the left and heard loudest in thesecond interspace near the left edge of the sternum—the pulmonaryarea. The Direction of Transmission. The first sounds are transmittedtoward the left axilla. They may be heard all over the cardiac area,but the position of maximum intensity is in the lower portion andtoward the left. The second sounds are loudest at the base of the heart. 436 PHYSICAL DIAG
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