. Diseases of the heart and arterial system; Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. Fig. 45.—Locaiion ok ApfcxiitAT andArea of Deep-seated in Mi-tral Stenosis. MITRAL STENOSIS 261 Another difference lies in the fact that, owing to atrophy in-stead of hypertrophy of the left ventricle, dulness is not likely tobe much if at all increased to the left. Auscultation.—In pronounced cases of mitral stenosis, auscul-tation at the apex of the heart detects a murmur of such intensityand distinctive character that it at once
. Diseases of the heart and arterial system; Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. Fig. 45.—Locaiion ok ApfcxiitAT andArea of Deep-seated in Mi-tral Stenosis. MITRAL STENOSIS 261 Another difference lies in the fact that, owing to atrophy in-stead of hypertrophy of the left ventricle, dulness is not likely tobe much if at all increased to the left. Auscultation.—In pronounced cases of mitral stenosis, auscul-tation at the apex of the heart detects a murmur of such intensityand distinctive character that it at once fastens the attention ofthe examiner. In most instances it is a long-drawn, rough bruit,which, beginning after the second sound, runs up to and termi-. FiG. -Khythm of Chaeacteristic Mukmue of Mitral Stenosis, Auricular-Systolic. nates abruptly in a clear, sharply accented first sound. The mur-mur is spoken of, therefore, as presystolic, and in this respect cor-responds exactly to the thrill already described. When wellmarked, this presystolic murmur is so striking as to be almostpathognomonic of mitral obstruction (Fig. 46). The rhythm of this bruit, by which is meant the time of itsoccurrence, has been the subject of considerable controversy, forthe reason that some observers have declared it to be in realitysystolic and only seemingly presystolic. The generation of thefirst sound, say they, is delayed in consequence of the rigidity ofthe mitral valve, and hence, although the murmur begins with thecontraction of the ventricle, its occurrence prior to the first tonegives it the appearance of preceding ventricular systole. Thearguments in support of this opinion have never convinced me of 262 DISEASES OF THE HEART its correctnes
Size: 2052px × 1217px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1910, bookiddiseasesofhe, bookyear1910
