. Medical diagnosis for the student and practitioner. s best conduction to the surface would be over the substernalportion of the right ventricle to which it is conducted by the chordce tendinea andpapillary muscles; but logically it should be heard clearly or even maximally TRICUSPID INSUFFICD N< \ 705 at times to the right of the sternum over the right auricle which receives theimpact of the regurgitant current. The Second Pulmonary Tone.—It is evident that the pressure withinthe ventricle during each systole is reduced and that the load driven intothe pulmonary arterv will ordinarily be
. Medical diagnosis for the student and practitioner. s best conduction to the surface would be over the substernalportion of the right ventricle to which it is conducted by the chordce tendinea andpapillary muscles; but logically it should be heard clearly or even maximally TRICUSPID INSUFFICD N< \ 705 at times to the right of the sternum over the right auricle which receives theimpact of the regurgitant current. The Second Pulmonary Tone.—It is evident that the pressure withinthe ventricle during each systole is reduced and that the load driven intothe pulmonary arterv will ordinarily be less in amount than is required and Effect of leak-lacking in force of projection. As a result the pulmonary second sound enednrignt(valvular closure) will be greatly diminished or even inaudible in the eventof any free leakage unless this be associated with a strongly overactingright ventricle. A markedly diminished second pulmonary tone at once suggests a failingright heart and tricuspid leakage, or a pulmonary insufficiency or stenosis, 1st st5d. Zd5d. Fig. 380.—Mitral and tricuspid regurgitation. Decompensation marked. Such aheart has repeatedly been aspirated for supposed pericardial effusion, though this error ismore likely to occur in a similar universal enlargement without murmurs. Bruits may ormay not be very obscure in such cases as this if the valvular lesions are wholly the resultof degenerative changes. (Flat-finger percussion.) the last being excessively rare lesions, usually congenital, associated with char-acteristic and well-defined murmurs. The right auricle must greatly dilate and hypertrophy in tricuspid regur-gitation though to a somewhat less degree than is the case with the left Throwing theauricle in mitral stenosis, in that the incoming systemic venous currents lackthe persistent and primarily inexorable drive maintained by the right ven-tricle against the crippled left auricle in the case of mitral lesions and alsobecause the right auricular o
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1922
