Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . ving a harsher,higher-pitched sound. (Fig. 68.) Over the carotids and distal arteries, diastolic mur-mur is detected in proportion to the freedom of regurgi-tation. (Duroziez.) A diastolic murmur is heard in addition to the nor-mal systolic murmur (pressure murmur) when thestethoscope is firmly pressed on the artery. It neveroccurs except in free aortic regurgitation, and is de-pendent upon a strong reflex current toward the slight regurgitation it is absent. In addi
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . ving a harsher,higher-pitched sound. (Fig. 68.) Over the carotids and distal arteries, diastolic mur-mur is detected in proportion to the freedom of regurgi-tation. (Duroziez.) A diastolic murmur is heard in addition to the nor-mal systolic murmur (pressure murmur) when thestethoscope is firmly pressed on the artery. It neveroccurs except in free aortic regurgitation, and is de-pendent upon a strong reflex current toward the slight regurgitation it is absent. In addition to the diastolic murmur, a systolic mur- 360 THE CIRCULATORY SYSTEM. mur is usually heard in the aortic area and over thearteries in well-marked cases of aortic systolic murmur may be due to true obstruction orto dilatation of the aorta (relative obstruction), whichoccurs in a greater or less degree in aortic true obstruction and regurgitation are com-bined at the aortic orifice, the systolic murmur is harsh,and carried into the vessels of the neck with diminished Fig. 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 weakne
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