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 . nt of sealing wax across the sur-face of the vein. Venous pulsation is specially pronounced whenarterial tension has been still further reduced by fever. Neitherof these last two phenomena is peculiar to aortic regurgitation, forthey may be observed in severe ansemia which has sufficientlylowered pulse-tension. They are, however, most distinct and typ-ical in aortic incompetence. Finally, when regurgitation is very free, a distinct thrill ma
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 . nt of sealing wax across the sur-face of the vein. Venous pulsation is specially pronounced whenarterial tension has been still further reduced by fever. Neitherof these last two phenomena is peculiar to aortic regurgitation, forthey may be observed in severe ansemia which has sufficientlylowered pulse-tension. They are, however, most distinct and typ-ical in aortic incompetence. Finally, when regurgitation is very free, a distinct thrill maybe felt in the cervical arteries and even in the brachials. This waswell felt in a man of about thirty-five, who died suddenly a fewweeks subsequently. In this case the thrill was palpable whenthe finger was laid ever so lightly on the vessel, and seemed to bebut the palpable expression of vibrations imparted to the arterialcoats by the suddenness and violence of the impact of the blood-stream. Percussion.—As in other cases of valvular disease, percussionaffords our best means of noting to what extent and in what direc- 302 DISEASES OF THE HEART. Fig. 56.—Type of Relative Dulness in Wellcompensated aortif! regurgitation. tion the heart has suffered enlargement. It is particularly valu-able in cases in which the size of the chest or the feebleness of cardiac impulse prevents usfrom judging of the size ofthe heart by inspection andpalpation. In compensatedcases cardiac dulness is in-creased only to the left anddownward, and the outlineof the left ventricle is ratherpointed (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
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