Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Mitral obstruction. Large arrow direction of current of blood. vents the transmission of the vibrations to the surfaceIn that direction, (c) The left ventricle being also in astate of relaxation and at its greatest distance from thechest wall, the vibrations, conducted to the surfacethrough the overlying lung, influence a very small areaof chest. (Fig. 63.) m A wider area of diffusion of the pre-systohc mitralmurmur is generally due either to unusually close rela- 20 306 THE
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Mitral obstruction. Large arrow direction of current of blood. vents the transmission of the vibrations to the surfaceIn that direction, (c) The left ventricle being also in astate of relaxation and at its greatest distance from thechest wall, the vibrations, conducted to the surfacethrough the overlying lung, influence a very small areaof chest. (Fig. 63.) m A wider area of diffusion of the pre-systohc mitralmurmur is generally due either to unusually close rela- 20 306 THE CIRCULATORY SYSTEM. tion of the apex of the left ventricle to the chest wall, orto increased power of conduction on the part of the tis-sues surrounding the apex of the heart, or to thecharacter of the vibrations. The pre-systolic murmur heard at the apex is gener-ally due to obstruction at the mitral orifice, althoughmurmurs with this rhythm and localization without Fig. Mitral systolic. mitral obstruction have been heard in aortic regurgita-tion (Flint murmur), in aortic obstruction and withadherent pericardium. Mitral Systolic Murmurs.—The point of maxi-mum intensity is at or close to the apex. The area ofdiffusion extends also around this point, and to the leftbeyond the prsecordia into the axillary region. () The murmur is also heard in the back, the point AUSCULTATION. 307 of maximum intensity being in the left interscapularspace, a little above the angle of the scapula, oppositethe spines of the fifth and sixth dorsal vertebra?. () The area of diffusion is usually limited to the leftscapular and interscapular regions. Fig. 65.
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