Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Aortic regurgitation, with slight regurgitation at mitral(beginning second stage). intensity; but, in proportion to the obstruction, thecarotid pulsations are less marked, and the pulse doesnot have the jerking, water-hammer character. When the systolic murmur is due to dilatation of theaorta, without diminution in the size of the aortic ori-fice, it is soft, blowing at the base of the heart, and holdsits intensity over the vessels, or may become louder; it isattended with ma
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Aortic regurgitation, with slight regurgitation at mitral(beginning second stage). intensity; but, in proportion to the obstruction, thecarotid pulsations are less marked, and the pulse doesnot have the jerking, water-hammer character. When the systolic murmur is due to dilatation of theaorta, without diminution in the size of the aortic ori-fice, it is soft, blowing at the base of the heart, and holdsits intensity over the vessels, or may become louder; it isattended with marked pulsation in the carotids and thecharacteristic pulse. The diastolic murmur is relatively DISEASES OF THE HEART. 361 more intense than the systolic, and is especially intenseover the carotids and distal arteries. The first sound ofthe heart is booming, and the pulmonic second sound isnot accentuated. Second Stage.—When incompetency occurs suddenlyat the mitral valve, due to muscular weakness, thediastolic murmur at the base becomes less intense; the Fig. Aortic stenosis and regurgitation with secondary mitral regurgitation. systolic murmur at the base becomes softer, and is nottransmitted so far into the vessels of the neck. Over theapex another systolic murmur is heard, due to mitralregurgitation. It has all of the characteristics of thatcondition, and is associated with accentuation of thepulmonic second sound. After mitral regurgitation has 362 THE CIRCULATORY SYSTEM. occurred, with temporary relief of the left ventricle,recompensation may occur, with persistence of themitral murmur. Increased power of the heart is shownby the returning harshness and loudness of both diastolicand systolic murmurs over the base of the heart. Third Stage.—With failure of compensation by theright ventricle, the murmurs become indistinct orabsent; there is a diminution of the pulmonic secondsound, and the tricuspid regurgitant murmur and thephysical signs of pulmonary congestion an
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