. Physical diagnosis . enin the suprasternal notch or in the second right interspace. Notonly the carotids but the subclavians, the brachials and radials,the femoral and anterior tibial, and even the digital and dorsalispedis arteries may visibly pulsate, and the characteristic jerkingquality of the pulse may be seen as well as felt. This visible pul-sation in the peripheral arteries? while very characteristic of aortic VALVULAR LESIONS. 231 regurgitation, is occasionally seen in cases of simple hypertrophy ofthe heart from hard muscular work {, in athletes). If the ar-teries are extensive
. Physical diagnosis . enin the suprasternal notch or in the second right interspace. Notonly the carotids but the subclavians, the brachials and radials,the femoral and anterior tibial, and even the digital and dorsalispedis arteries may visibly pulsate, and the characteristic jerkingquality of the pulse may be seen as well as felt. This visible pul-sation in the peripheral arteries? while very characteristic of aortic VALVULAR LESIONS. 231 regurgitation, is occasionally seen in cases of simple hypertrophy ofthe heart from hard muscular work {, in athletes). If the ar-teries are extensively calcified, their pulsation become much lessmarked. The peculiar conditions of the circulation whereby it is changedinto a series of discontinuous discharges as if from a catapult (All-butt) throws a great tensile strain upon all the arteries, and results,in almost every long-standing case, in increasing both their length Pulsation at the jugulum. Dulness and pul-sation corre- -•»sponding to thedilated Pulsating car-otids. Diastolic murmur. Displaced cardiacimpulse. Fig. XM— Aortic Regurgitation, Showing Position of the Diastolic Murmur and Areas of Visible Pulsation. and their diameter. The visible arterial trunks become tortuousand distended, while the arch of the aorta is diffusely dilated andbecomes practically an aneurism (see Fig. 134). With each heartbeat the snaky arteries are often jerked to one side as well as madeto throb. Inspection of the region of the cardiac impulse almost alwaysshows a very marked displacement of the apex beat both downwardand outward (but especially the former), corresponding to the hy-pertrophy and still more to the dilatation of the left ventricle, 232 PHYSICAL DIAGNOSIS. which is usually very great, and to the downward sagging of theenlarged aorta. Dilatation is in this disease an essentially helpfuland compensatory process. In a small proportion of the cases noenlargement of the heart is to be demonstrated. This was true
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