. 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. Fio. 48.—Rhythm of Occasional Variety of Mitual Stenotic Murmur, thkouohEntire Ventrioixak Diastole. tlien succeeded l)y a short period of silence, and then a character-istic presystolic murmur (Fig. 49). 1his anomaly is therefore abreaking in two, as it were, of the long murmur, and by Fraentzel MITRAL STENOSIS 265 was called the interrupted modified presystolic murmur. It isvery diagnostic, but may easily mislead an inexperienced auscul-ta
. 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. Fio. 48.—Rhythm of Occasional Variety of Mitual Stenotic Murmur, thkouohEntire Ventrioixak Diastole. tlien succeeded l)y a short period of silence, and then a character-istic presystolic murmur (Fig. 49). 1his anomaly is therefore abreaking in two, as it were, of the long murmur, and by Fraentzel MITRAL STENOSIS 265 was called the interrupted modified presystolic murmur. It isvery diagnostic, but may easily mislead an inexperienced auscul-tator. Should such difficulty of interpretation arise, error may be. Fig. 49.— Interrupted Modified Presystolic Murmur of Mitral Stenosis. avoided by due attention to the associated secondary physical signsand to the modifications of the heart-sounds soon to be described. Another departure from what is usually heard in mitral ste-nosis is the retention of the presystolic bruit and of the first soundwithout a second sound, or of the murmur alone ivithout either ofthe cardiac tones. Attention is directed to these anomalies byBroadbent, who states that under such circumstances it is possiblefor the murmur to be mistaken for a systolic one followed by asecond sound, or for the bruit to be considered systolic, and tohave replaced the sound altogether. Care should be taken to avoidsuch an error, since a systolic murmur means regurgitation, andfor sake of prognosis as well as treatment stenosis should be recog-nised as such whenever it exists. A mistake can probably beavoided by palpation of the carotid pulse, when it will be foundthat this is preceded by t
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