. Diseases of the heart and thoracic aorta. disease, when the leftauricle is much dilated, when its muscular wall is weakand degenerated, or when, as in some rare cases, its cavity-is occluded by a thrombus, the blood current does not passthrough the narrowed orifice with sufficient force to produce afluid vein ; in these cases the murmur is absent. It is, in fact, common to meet with extreme constriction ofthe mitral orifice on the post-mortem table, which was notaccompanied by any presystolic murmur during life (I meanof course during the later stages of the case). Indeed DrHilton Fagge goes
. Diseases of the heart and thoracic aorta. disease, when the leftauricle is much dilated, when its muscular wall is weakand degenerated, or when, as in some rare cases, its cavity-is occluded by a thrombus, the blood current does not passthrough the narrowed orifice with sufficient force to produce afluid vein ; in these cases the murmur is absent. It is, in fact, common to meet with extreme constriction ofthe mitral orifice on the post-mortem table, which was notaccompanied by any presystolic murmur during life (I meanof course during the later stages of the case). Indeed DrHilton Fagge goes so far as to say, my impression is that inthe large majority of the cases in which mitral stenosis isfound after death, there is no record of the presence of a pre-systolic murmur during life.^ Again, in exceptional cases, the murmur, instead of beingpresystolic, occurs during the first part of the diastole or longpause, and is separated from the first sound of the heart by adistinct interval. (See fig. 200.) In cases of this Fig. 203.—Diagrammatic representation of post-diastolic murmur, which occursin some rare cases of mitral stenosis. It is separated from the commencement ofthe first sound by an appreciable interval. the conditions which produce the passage of the blood fromthe cavity of the left auricle to the cavity of the left ventricleat the beginning of the ventricular diastole, must be in ex-cess. Now these conditions are :—(i) the pressure of the bloodin the cavity of the left auricle and pulmonary veins ; and(2) the suction force which results from the elastic recoil of theleft ventricle itself If either of these forces were in excess,the blood current might pass through the constricted mitralorifice at the coninienccnicnt of the ventricular diastole \\ith Russia Reynold/ Sys/ciu of MeJiciiic, vol. iv. p. 674. PJiysical Signs of Mitral Stenosis. 487 sufficient force to produce an audible fluid vein, which wouldbe heard externally as a diastolic mu
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectheart, bookyear1884
