. Medical diagnosis for the student and practitioner. Compare with the ptotic type of heart shownon the following page. (a) A base at the level of the upper border of the third costal cartilages. (b) A right border formed chiefly by the right auricle, save in the case ofthe drop heart, curving from the right base downward to the sixth chondro-sternal articulation and attaining in robust individuals a distance from cm. from the midstemal line under the fourth interspace. 428 MEDICAL DIAGNOSIS The total of the right and left transverse heart diameters seldom cm. and may not
. Medical diagnosis for the student and practitioner. Compare with the ptotic type of heart shownon the following page. (a) A base at the level of the upper border of the third costal cartilages. (b) A right border formed chiefly by the right auricle, save in the case ofthe drop heart, curving from the right base downward to the sixth chondro-sternal articulation and attaining in robust individuals a distance from cm. from the midstemal line under the fourth interspace. 428 MEDICAL DIAGNOSIS The total of the right and left transverse heart diameters seldom cm. and may not be greater than 8 or even cm. in emaciated con-genially asthenic subjects (see Drop Heart). In the latter cases the right border may not pass beyond the right edge ofthe sternum. (c) A left border, which sweeps outward, downward, and then slightlyinward, to a point in the fifth interspace, varying between and cm.(2% to 3% inches) from the median line, according to the weight and buildof the patient and the type of heart. Small Fig. 158.—The drop heart of congenital asthenia and visceroptosis. Normal heartcontour and elevation shown by dotted lines. (Schivarz modified.) * Found in a consider-able proportion of the population and in all grades it constitutes a most misleading variantand is responsible for a vast number of missed diagnoses of an existing cardiac en-largement. In persons of the congenital asthenic type, be they fat or thin, the total dimen-sions normally fall short of the measurements ordinarily given as the normal. (d) A lower border connecting the lower extremities of the lines represent-ing the right and left borders. Variations in posture as between the sitting and recumbent position affectthe total transverse measurement but slightly. * The position of the auricle in the typical drop heart is indicated also by a dottedline. The angles or notches of the left border are exaggerated as compared with the usualroentgenographic picture. Such
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1922
