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 . was wanting;throughout the prsecordiumthe sounds were obscured bymurmurs, both systolic anddiastolic, which were audibleover the entire cardiac area,but were of maximum inten-sity in the aortic area and onthe body of the sternum. Asnapping systolic tone was audible in the femoral artery. In theaortic area bimanual palpation with slight pressure brought outa systolic shock and thrill. Examination of abdomen and urinewas negative. The diagnosi
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 . was wanting;throughout the prsecordiumthe sounds were obscured bymurmurs, both systolic anddiastolic, which were audibleover the entire cardiac area,but were of maximum inten-sity in the aortic area and onthe body of the sternum. Asnapping systolic tone was audible in the femoral artery. In theaortic area bimanual palpation with slight pressure brought outa systolic shock and thrill. Examination of abdomen and urinewas negative. The diagnosis lay between aneurysm of the ascending aortaand insufficiency of the aortic valves, but the lesion was subse-quently decided to be a valvular one of sclerotic, possibly syphiliticorigin. For the next few months the patient was seen at rather infre-quent intervals until the last of March, 1897. In February ofthat same year patient was knocked down by a runaway horse,but did not think he sustained special injury. Towards end ofMarch he began to complain of insomnia, great nervousness, andrestlessness. The heart was rapid and pounding, and there was. Fig. 28.—Apex-beat and Eelative Dul-ness, Case of Acute Endocarditis (). 160 DISEASES OF THE HEART dyspnoea, even in repose, which increased paroxysmally withoutcause. Urine analysis showed pus, blood, and albumin. Patient was ordered to keep to the house and confine himselfto milk diet, with potassium citrate and tincture of digitalis insmall doses, with saline cathartics daily. After about two monthsthe urine lost all traces of blood and albumin, but patients gen-eral condition grew worse, and he was ordered to keep his action was still rapid and pounding, but regular, and dysp-noea with paroxysmal exacerbations very marked. Patient sweatedprofusely, but the thermometer never showed fever. One night complained of pain in right hypochondrium belowribs, embolism was suspected, but subsequently doubted. Liverreached
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