Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . er signs of pulmonic congestion, and later with thoseof the third stage—venous congestion and tricuspidregurgitation. (See Mitral Eegurgitation.) Diagnosis of the Pathological Condition.—The diagnosisof aortic stenosis from other conditions causing a sys-tolic murmur over the aortic area is made by the asso-ciation with the murmur (a) the signs of primarycardiac hypertrophy of the left ventricle, (o) thepresence of a thrill, (c) the characteristic contrast be-tween the force
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . er signs of pulmonic congestion, and later with thoseof the third stage—venous congestion and tricuspidregurgitation. (See Mitral Eegurgitation.) Diagnosis of the Pathological Condition.—The diagnosisof aortic stenosis from other conditions causing a sys-tolic murmur over the aortic area is made by the asso-ciation with the murmur (a) the signs of primarycardiac hypertrophy of the left ventricle, (o) thepresence of a thrill, (c) the characteristic contrast be-tween the force of the apex beat and the size of the pulse. DISEASES OF THE HEART. 349 Aortic obstruction rarely continues as an isolatedlesion for any length of time, being usually associatedwith regurgitation. In uncomplicated stenosis the aorticsecond sound is impure, muffled and lacks the normaltense, valvular element. When regurgitation occurs theaortic sound becomes very feeble, or is replaced by themurmur. Roughening of the surface of the valves gives a softsystolic murmur, which is localized around a point of Fig. Aortic obstruction and dilatation of aorta. maximum intensity at the second left intercostal space;the aortic second sound is clear, and there is no changein the position and force of the apex beat or in the sounds are identical with the early stage of acuteendocarditis at the aortic valve, that may ultimatelyproduce true obstruction. Dilatation of the aorta, altering the correlation be-tween the size of the aortic orifice and the cavity beyond, 350 THE CIRCULATORY SYSTEM. frequently causes a murmur. The early changes due toatheroma diminish the elasticity of the aorta, convertingit into a rigid tube, increasing the work of the heart, andcausing hypertrophy of the left ventricle. If the aorticsurfaces are also roughened a harsh murmur will bepresent, the aortic second sound will be accentuated, andthere will be more marked distension and pulsation ofthe v
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