. Physical diagnosis . he second sound there is a pause corresponding to 1 For exceptions to this rule, see below, page 235. 2 The first sound of the heart, as heard at the apex, may be imitated byholding a linen handkerchief by the corners and suddenly tautening one of theborders. To imitate the second sound, use one-half the length of the borderinstead of the whole. AUSCULTATION OF THE HEART. 173 the diastole of the heart. Normally this pause occupies a littlemore time than the first and second sounds of the heart taken to-gether. In disease it may be much shortened. The first sound of the h
. Physical diagnosis . he second sound there is a pause corresponding to 1 For exceptions to this rule, see below, page 235. 2 The first sound of the heart, as heard at the apex, may be imitated byholding a linen handkerchief by the corners and suddenly tautening one of theborders. To imitate the second sound, use one-half the length of the borderinstead of the whole. AUSCULTATION OF THE HEART. 173 the diastole of the heart. Normally this pause occupies a littlemore time than the first and second sounds of the heart taken to-gether. In disease it may be much shortened. The first sound of the heart is not only longer and duller thanthe second (it is often spoken of as booming in contrast with the snapping quality of the second sound) but is also considerablymore intense, so that it gives us the impression of being accentedlike the first syllable of a trochaic rhythm. After a little practiceone grows so accustomed to this rhythm that one is apt to rely upon ,— Aortic valve. Tricuspid valve. ~. Mitral valve. / Fig. 109.—Anatomical Position of the Cardiac Valves. his appreciation of the rhythm alone for the identification of thesystolic sound. This is, however, an unsafe practice and leads tomany errors. Our impression as to which of the two sounds of eachcardiac cycle corresponds to systole should always be verified eitherby sight or touch. We must either see or feel the cardiac impulseand assure ourselves that it is synchronous with the heart soundwhich we take to be This point is of especial importancein the recognition and identification of cardiac murmurs, as will beseen presently. 1 When the cardiac impulse can be neither seen nor felt, the pulsation ofthe carotid will generally guide us. The radial pulse is not a safe guide. 174 PHYSICAL DIAGNOSIS. So far, I have been describing the normal heart sounds heardin the mitral area, that is, at the apex of the heart. If now welisten over the pulmonary area (in the second left intercostalsp
Size: 1612px × 1550px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, bookpublis, booksubjectdiagnosis
