Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . times some distance from the patient. Whenthe opening is large the murmur is more gushing, andrapidly diminishes in loudness. When a murmur thathas been loud becomes weaker and shorter, it indicateslow pressure in the aorta, due to failure of cardiacpower or decrease of resistance in capillaries. The duration of the murmur and its relation to thenormal cardiac sounds are important data in determin-ing the nature and extent of the lesion. The longer themurmur persists during d
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . times some distance from the patient. Whenthe opening is large the murmur is more gushing, andrapidly diminishes in loudness. When a murmur thathas been loud becomes weaker and shorter, it indicateslow pressure in the aorta, due to failure of cardiacpower or decrease of resistance in capillaries. The duration of the murmur and its relation to thenormal cardiac sounds are important data in determin-ing the nature and extent of the lesion. The longer themurmur persists during diastole, retaining the samedegree of loudness, the smaller is the amount of bloodthat regurgitates through the valves and the slighter theeffect on blood pressure in the aorta. Murmurs which 358 THE CIRCULATORY SYSTEM. are heard for a short time only during the early portionof diastole, and rapidly diminish in loudness*, indicatefree regurgitation. The murmur may accompany, follow or take the placeof the aortic second sound, according to the condition ofthe valves. When the incompetency is due to vegeta- Fig. Aortic regurgitation (first stage). tions or deformities limited to one cusp, or when allthe cusps are involved, but their elasticity is notdestroyed, the aortic second sound may persist, and themurmur will accompany or follow it. In such cases theregurgitation is generally small, although free regurgi-tation may occur with persistence of the second sound. DISEASES OF THE HEART. 359 When incompetency of the cusps is secondary toarterial disease or dilatation of the aorta, an accentuatedaortic second sound may persist with the the second sound is absent or the murmur replacesit, regurgitation is usually free, and not associated withstenosis. The point of maximum intensity and the area of dif-fusion vary greatly. The murmur may be heard loudestin the aortic area, over the sternum, opposite the thirdinterspace, at the ensiform cartilage, and at the apex,or it
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