Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . irst sound (pre-systolic) ; the point of maximum intensity is at the apex,around which it is diffused. The above are characteristics of the typical murmurof mitral obstruction, but it is subject to variations inquality, duration and intensity, dependent upon thedegree and character of the obstruction and the forceof the current of blood through the opening. The murmur has been described as rough, rumbling,rolling, churning, grinding, blubbering, and may besimulated by pronoun
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . irst sound (pre-systolic) ; the point of maximum intensity is at the apex,around which it is diffused. The above are characteristics of the typical murmurof mitral obstruction, but it is subject to variations inquality, duration and intensity, dependent upon thedegree and character of the obstruction and the forceof the current of blood through the opening. The murmur has been described as rough, rumbling,rolling, churning, grinding, blubbering, and may besimulated by pronouncing the syllables rrb, rrt. The most distinctive feature is the short, sharp soundthat terminates the murmur, which always persists,even though the other phases of the murmur are may be the only sign present of mitral obstruction,as the murmur is not constant. DISEASES OF THE HEART. 339 The production of a murmur demands that the bloodpass through the contracted orifice with a definiteamount of force. As the rapidity of the passage of theblood through the heart varies from time to time, accord- Fig. Congenital mitral stenosis (rhachitic thorax).X Ray tracing of outline of the heart. nig to the rate of cardiac action, the murmur may beabsent at one time and present at another. Variationsm the force of the current also cause a rise and fall inthe intensity of the murmur. 340 THE CIRCULATORY SYSTEM. The duration of the murmur and its relation to thefirst and second sounds of the heart also vary. Whenthe murmur is heard only for a brief period, just beforethe first sound, it is distinctly pre-systolic. The dura-tion may be longer, however, so that it occupies themajor portion of diastole, or in some cases it may beheard with greatest intensity almost immediately afterthe occurrence of the second sound; but this murmurcan never occur with or replace the second sound of the heart. (Fig. 61.) The presence of a murmur during the different por-tions of diastole depends u
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