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 . monic valve, is sometimes felt distinctly in thesecond left interspace, close to the sternum. Epigastric pulsationis generally pronounced, and gives the impression of a powerfullycontracting right ventricle. In compensated cases of stenosis the pulse is small, feeble, andregular, and less rapid than in mitral regurgitation. There has been much controversy, chiefly among the English,as to whether the pulse of mitral obstruction or of insuffic
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 . monic valve, is sometimes felt distinctly in thesecond left interspace, close to the sternum. Epigastric pulsationis generally pronounced, and gives the impression of a powerfullycontracting right ventricle. In compensated cases of stenosis the pulse is small, feeble, andregular, and less rapid than in mitral regurgitation. There has been much controversy, chiefly among the English,as to whether the pulse of mitral obstruction or of insufficiency isthe more likely to be irregular. This, in my opinion, is a matterof slight practical importance, and yet in my experience I havefound the pulse to be more often irregular in regurgitation than instenosis. The annexed sphygmographic tracing (Eig. 44) is from a caseof pronounced mitral stenosis in a female, and shows the pulsesmall, of high tension, and regular. When pulse-tension is pro-nounced, it is due to capillary resistance and not to the energy ofleft ventricular contraction. Concerning the irregularity of the 2G0 DISEASES OF THE HEART. Fig. 44.—Sphygmogram from Case of Mitral Stenosis. (Personal observation.) pulse in mitral disease, it may be again stated that observations ofEadizewsky appear to prove that the character of the pulse in thisrespect depends upon the stateof the myocardium of the au-ricles. When this is healthy,the pulse is regular; whendegenerated, either fibroid orfatty, the pulse becomes irreg-ular, even arrhythmic. Popoff has called attention to the occasional occurrence of apulsus differens in this disease, by which term is meant an ine-quality in the two radial pulses, the left being the smaller. Asthis is observed when compensation is destroyed, and may dis-appear with restoration of cardiac energy, Popoff attributes theinequality to pressure of the greatly dilated left auricle on the leftsubclavian artery. Preble has also noticed its occur
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