Diseases of the chest and the principles of physical diagnosis . seems that the position depends upon the size of the heart, which inturn depends upon the amount of blood it contains, which is in turn de-termined by the stage of compensation. When the heart is w^ell filledwith blood its position is relatively normal, but when it is small and partlycollapsed it may fall backward against the posterior pericardial wall; theapex being more or less displaced toward the right. Occasionallj^ it may 260 THE EXAMINATION OF CIKCULATORY SYSTEM remain in an anterior position, in which it is mainta
Diseases of the chest and the principles of physical diagnosis . seems that the position depends upon the size of the heart, which inturn depends upon the amount of blood it contains, which is in turn de-termined by the stage of compensation. When the heart is w^ell filledwith blood its position is relatively normal, but when it is small and partlycollapsed it may fall backward against the posterior pericardial wall; theapex being more or less displaced toward the right. Occasionallj^ it may 260 THE EXAMINATION OF CIKCULATORY SYSTEM remain in an anterior position, in which it is maintained bj- the elasticityof the great vessels. Effusions amounting to 750 may be sufl&cient to cause the dis-appearance of all friction sounds even at the base, but on the other handa friction may persist with effusions of 1000 or more. Pleuro-pericardial sounds are due to roughening of the external sur-faces of the pleura and the pericardium. They are heard best at the leftanterior pulmonary border, are often affected by respiration, posture, Fig. 218.—Pericabdi.\l adhesions. The illustration shows dense, localized, fibrousadhesions near the apex of the heart (which is dilated), the result of antecedent pericardialinflammation. Such a condition is suggested by localized systolic retraction of the chestwall, especially if associated with diminished postural mobility of the heart, with symptomsof cardiac insufficiency out of proportion to the demonstrable physical signs, lack of responseto the usual methods of treatment (digitalis, rest, etc.), especially if coupled with a historyof a previous attack of rheumatic fever or pneumonia. (From Aorris Cardiac Path-ology.) PRACTICAL CONSIDERATIONS In examining the heart, observations should always be made in boththe erect and in the recumbent posture. The results thus obtained areoften variable, and physical signs absent in one position may be readilydemonstrable in the other. When the findings are recorded, the positio
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1920
