Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Aortic obstruction. Aortic Diastolic Murmurs.—The point of maximumintensity is not, as usually described, at the secondright intercostal cartilage, but over the sternum and atthe left edge, opposite the third interspace or fourthcostal cartilage. The area of diffusion is downwardalong the sternum, and also to the apex of the leftventricle. (Fig. 68.) Conduction of the aortic regurgi- AUSCULTATION. 311 tant murmur to the sternum at the point of maximumintensity is due to the i
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Aortic obstruction. Aortic Diastolic Murmurs.—The point of maximumintensity is not, as usually described, at the secondright intercostal cartilage, but over the sternum and atthe left edge, opposite the third interspace or fourthcostal cartilage. The area of diffusion is downwardalong the sternum, and also to the apex of the leftventricle. (Fig. 68.) Conduction of the aortic regurgi- AUSCULTATION. 311 tant murmur to the sternum at the point of maximumintensity is due to the intimate relation of the aorticcusps with the auric ulo-ventricular septum of the rightside of the heart. The vibrations made by the regurgi-tant stream are transmitted from the aortic valvesthrough the right auriculo-ventricular septum to thatportion of the sternum that is in closest contact with it,viz.: from the third left interspace to the sixth rib on Fig. Aortic regurgitation. the right side. Conduction of the murmur to the apexof the left ventricle is by the regurgitant stream. () The character of the murmur heard at the apexmay differ greatly from that present over the in the location of the point of maximumintensity and area of diffusion are dependent upon thecause and the nature of the secondary changes in theheart and aorta. (See Aortic Eegurgitation.) 312 THE CIRCULATORY SYSTEM. Regurgitation at the aortic orifice may depend upon(a) absolute insufficiency of the valves, due to vegeta-tions, loss of substance, thickening and distortion of thevalves, congenital malformation (rare) ; (b) upon rupt-ure of the valves; (c) upon relative insufficiency, aswhen the valves are normal, but insufficient to close theorifice on account of dilatation of the aortic ring. Fig. 69.
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