Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Aortic regurgitation. the right side. Conduction of the murmur to the apexof the left ventricle is by the regurgitant stream. () The character of the murmur heard at the apexmay differ greatly from that present over the in the location of the point of maximumintensity and area of diffusion are dependent upon thecause and the nature of the secondary changes in theheart and aorta. (See Aortic Eegurgitation.) 312 THE CIRCULATORY SYSTEM. Regurgitation at
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Aortic regurgitation. the right side. Conduction of the murmur to the apexof the left ventricle is by the regurgitant stream. () The character of the murmur heard at the apexmay differ greatly from that present over the in the location of the point of maximumintensity and area of diffusion are dependent upon thecause and the nature of the secondary changes in theheart and aorta. (See Aortic Eegurgitation.) 312 THE CIRCULATORY SYSTEM. Regurgitation at the aortic orifice may depend upon(a) absolute insufficiency of the valves, due to vegeta-tions, loss of substance, thickening and distortion of thevalves, congenital malformation (rare) ; (b) upon rupt-ure of the valves; (c) upon relative insufficiency, aswhen the valves are normal, but insufficient to close theorifice on account of dilatation of the aortic ring. Fig. Aortic regurgitation. Arrows show lines of conduction of vibrations. Murmurs Made at the Tricuspid Valve.—Tricuspidmurmurs are usually most distinct over the lower por-tion of the sternum and along the lower left costalcartilages. Tricuspid Pre-systolic Murmurs.—The point ofmaximum intensity is over the lower portion of thesternum, at the upper edge of the ensiform cartilage,and the area of diffusion corresponds with the area of AUSCULTAT10X. 313 superficial cardiac flatness. (Fig. 70.) Conductionto the surface of the vibrations made at the tricuspidvalve is from that portion of the right ventricle which isin direct contact with the sternum. The tricuspid pre-systolic murmur is extremely rare,and, when detected, is diagnostic of obstruction at theorifice, either congenital or acquired. Fig. 70.
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