Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Mitral systolic. The murmur made at the mitral valve (situatedbehind the left half of the sternum at the level of thefourth costal articulation) reaches the surface in frontover the apex of the heart and behind in the scapular re-gion by two different lines of conduction. (Tig. 66.) 308 THE CIRCULATORY SYSTEM. Conduction to the apex is mainly by the tissues of theleft ventricle, which at the time of the first sound of theheart are in a state of extreme tension. The vibrations
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Mitral systolic. The murmur made at the mitral valve (situatedbehind the left half of the sternum at the level of thefourth costal articulation) reaches the surface in frontover the apex of the heart and behind in the scapular re-gion by two different lines of conduction. (Tig. 66.) 308 THE CIRCULATORY SYSTEM. Conduction to the apex is mainly by the tissues of theleft ventricle, which at the time of the first sound of theheart are in a state of extreme tension. The vibrationsmade by the regurgitant stream are transmitted (a) bythe leaflets of the mitral valve through the tense chordseatendinese and papillary muscle to the apex of the leftventricle, (b) The apex of the left ventricle at this Fig. Mitral regurgitation. Large arrow shows direction of current ofblood. Small arrows show conduction of vibration to the apex bychordae tendineae and papillary muscles. time is in closer contact with the chest wall, to which ittransmits the vibrations of the murmur, (c) From thepoint of contact (the point of maximum intensity) thevibrations are conveyed along the ribs in all directions(diffusion). Over the prsecordia they are deadened bythe right ventricle, so that their diffusion to the rightand upwards- is limited. The vibrations are conveyed AUSCULTATION. 309 by the ribs to the axillary region. The murmur isheard over wider area when the left ventricle is muchhypertrophied, and the apex is displaced downward andto the left, and is in contact with the chest wall to agreater extent. (Fig. 76.) Conduction of the mitral regurgitant murmur to thescapular region is from the left auricle, which is throwninto vibration by the stream of regurgitant blood. Fromthe auricle the vibrations are tr
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