Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Pulmonic systolic—stenotic. Murmurs at the Pulmonary Orifice. Pulmonic Sys-tolic Murmurs.—The point of maximum intensity isat the left intercostal space, close to the sternum. Thearea of diffusion may be circumscribed around the pointof maximum intensity, or may extend upward along thecourse of the pulmonary artery and laterally to the left.(Fig. 72.) 316 THE CIRCULATORY SYSTEM. The occurrence of a systolic murmur at the pulmonicarea is extremely common, and may be due (a) to
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Pulmonic systolic—stenotic. Murmurs at the Pulmonary Orifice. Pulmonic Sys-tolic Murmurs.—The point of maximum intensity isat the left intercostal space, close to the sternum. Thearea of diffusion may be circumscribed around the pointof maximum intensity, or may extend upward along thecourse of the pulmonary artery and laterally to the left.(Fig. 72.) 316 THE CIRCULATORY SYSTEM. The occurrence of a systolic murmur at the pulmonicarea is extremely common, and may be due (a) toorganic changes in the valves, producing obstruction(rare), or (b) to narrowing of the lumen of the pul-monary artery by changes in the surrounding structuresor torsion from displacement of the heart; (c) toanaemia, either alone or associated with dilatation of the Fig. Pulmonic systolic anaemic murmur. artery (most commonly). In anaemic murmurs thepoint of maximum intensity and area of diffusion ismore variable than in those dependent on stenosis atorifice. (Figs. 73 and 74.) Pulmonic Diastolic Murmurs.—This murmur isvery rare. The point of maximum intensity is over thepulmonic valve area. The area of diffusion is along the AUSCULTATION. 31 left edge of the sternum. It may occur (a) from con-genital malformation or ulcerative endocarditis; (b)from relative insufficiency caused by dilatation of thepulmonary artery or orifice. (Fig. 75.) Exocardial Murmurs. A. Arterial Murmurs.—Thepresence over the aorta of the normal cardiac sounds, andof murmurs made at the aortic orifice and in aorta, has Fig. 74.
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