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 . ointed (Fig. 56). As dila-tation comes on, the left car-diac border becomes morerounded and the apex is bluntand broad, so that one shouldalways strive to percuss outthe shape of the left ventricleas well as its distance fromthe median line (Fig. 57).Increased dulness to the right is present only secondarily, and isa measure of back pressure important to determine. Auscultation.—Regurgitation through the aortic valves de-clares itself by a m
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 . ointed (Fig. 56). As dila-tation comes on, the left car-diac border becomes morerounded and the apex is bluntand broad, so that one shouldalways strive to percuss outthe shape of the left ventricleas well as its distance fromthe median line (Fig. 57).Increased dulness to the right is present only secondarily, and isa measure of back pressure important to determine. Auscultation.—Regurgitation through the aortic valves de-clares itself by a murmur syn-chronous with the secondheart sound and thereforediastolic in time, which isheard with greatest intensityover the base of the heart any-where between the secondright costo-sternal articulationand the junction of the fifthleft costal cartilage with thebreastbone (Figs. 58 and 59).Its most usual seat of maxi-mum loudness is on the bodyof the sternum at the level ofthe third costal cartilage, and yet in Some instances it may ^d. < of Relative Dulness in^ d Poorly Compensated Aortic Regurgi- be heard most plainly or heard AORTIC REGURGITATION .,:, only in the fourth left interspace, close to the breastbone. It: isgenerally most distinct in the erecl position or when the heartsaction is excited. Neverthe-less I have certainly observedcases in which the murmur be-came more distinct and easilyrecognised when the patientwas recumbent. This murmuris transmitted downward to-wards the ensiform appendix,and in some instances alsotowards the left, even as faras the apex. When audible,with more than usual inten-sity at the apex, the murmuris thought by some to indicateincompetence of the left pos-terior flap. As previously remarkedwith reference to the mitralregurgitant murmur, the intensity and the extent of conduction ofthis aortic diastolic murmur furnish no criterion of the gravity of
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