Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . to the point ofmaximum intensity. The vibrations are transmittedthrough the walls of the aorta to the manubrium sterniand clavicles. (Fig. 67.) Systolic murmurs in the aortic region may be causedby conditions that lead to the production of vibrationsat the valve orifice itself or in the aorta just the orifice: (1) Narrowing of the lumen of theopening by changes in the valves (stenosis) (2)Roughening of the surfaces by vegetations, calcareousdeposits without diminuti
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . to the point ofmaximum intensity. The vibrations are transmittedthrough the walls of the aorta to the manubrium sterniand clavicles. (Fig. 67.) Systolic murmurs in the aortic region may be causedby conditions that lead to the production of vibrationsat the valve orifice itself or in the aorta just the orifice: (1) Narrowing of the lumen of theopening by changes in the valves (stenosis) (2)Roughening of the surfaces by vegetations, calcareousdeposits without diminution in the size of the orifice(non-stenotic). In the aorta: (1) Roughening of theinner walls of the aorta. (2) Dilatation of the aorta. 310 THE CIRCULATORY SYSTEM. Inorganic causes: (1) Functional or dynamic, due toincrease of cardiac force, as in cardiac overaction causedby mental or emotional excitement, physical exertion,Graves disease. (2) Hsemic or anaemic. Murmurs due to anaemia are heard in the aortic areaor over the sternum, but are transmitted into the vesselsof the neck with increasing intensity. Fig. Aortic obstruction. Aortic Diastolic Murmurs.—The point of maximumintensity is not, as usually described, at the secondright intercostal cartilage, but over the sternum and atthe left edge, opposite the third interspace or fourthcostal cartilage. The area of diffusion is downwardalong the sternum, and also to the apex of the leftventricle. (Fig. 68.) Conduction of the aortic regurgi- AUSCULTATION. 311 tant murmur to the sternum at the point of maximumintensity is due to the intimate relation of the aorticcusps with the auric ulo-ventricular septum of the rightside of the heart. The vibrations made by the regurgi-tant stream are transmitted from the aortic valvesthrough the right auriculo-ventricular septum to thatportion of the sternum that is in closest contact with it,viz.: from the third left interspace to the sixth rib on Fig. G8.
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