Diseases of the chest and the principles of physical diagnosis . d is often loud and somewhat rasping, andin children the pulmonic second sound, loud. These signs may lead toan erroneous diagnosis of mitral obstruction, especially since with arapid heart action a normal systolic thrill may be interpreted as beingpresystolic, and inasmuch as a normal presystolic sound is sometimesaudible (see p. 221). Such cases may be differentiated from mitral obstruction by the factthat in the latter condition the heart is enlarged, the pulse volume small,the rate not infrequently irregular, while the pulmon
Diseases of the chest and the principles of physical diagnosis . d is often loud and somewhat rasping, andin children the pulmonic second sound, loud. These signs may lead toan erroneous diagnosis of mitral obstruction, especially since with arapid heart action a normal systolic thrill may be interpreted as beingpresystolic, and inasmuch as a normal presystolic sound is sometimesaudible (see p. 221). Such cases may be differentiated from mitral obstruction by the factthat in the latter condition the heart is enlarged, the pulse volume small,the rate not infrequently irregular, while the pulmonic second sound isunduly accentuated. In addition to these signs the patient with astenotic lesion is apt to suffer from dyspnea, cyanosis, or cough on severeexertion. iNoRRis, G. W.: Studies in Cardiac Pathology, 1911, 123. PALPATION 205 Pathologic Thrills.—Thrills of pathologic origin are encountered invalvular heart disease and in aneurism. Thrills may also be felt inthe large arteries and veins, as well as over the thyroid gland in exoph- \ R.\. Fig. 166.—Sectiox through the middle of the sterxum axd vertebral coLtriiN(adultj. Sho-wing the anatomic relations of various cardiac structures. At tMs point theheart occupies practically the entire mediastinal space. The esophagus lies closely behindthe left auricle. Venous tracing depicting the functional activity may be made by intro-ducing a rubber capsule into the esophagus. T., trachea; , left innominate vein;, right auricular appendage; , right ventricle; A., aorta; !., right pulmo-nary arterj^; , left bronchus; , left auricle; , right auricle; A, abdominal aorta;, inferior vena cava. thalmic goitre. The most intense systolic thrills are generally met within aortic obstruction, and pulmonary stenosis. Very marked diastolicthrUls are frecpentlj encountered in aortic insufficiency and mitralobstruction. CHAPTER XVIIIPERCUSSION OF THE HEART The heart is outlined by percus
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