. Medical diagnosis for the student and practitioner. ) dilatation and hypertrophy of the left ventricle; and,(c), hypertrophy of the right ventricle, which, of the three chambers involved, isprimarily least directly or violently afected because of the interposed arterio-capillary area of the lungs. Great Variation in Lesions.—The smaller the lesion and the more gradualits production or increase, the more insignificant will be the primary changesand, as a matter of fact, true regurgitation may be either temporary orpermanent, so free as to abolish the murmur in weakened hearts when thestasis p
. Medical diagnosis for the student and practitioner. ) dilatation and hypertrophy of the left ventricle; and,(c), hypertrophy of the right ventricle, which, of the three chambers involved, isprimarily least directly or violently afected because of the interposed arterio-capillary area of the lungs. Great Variation in Lesions.—The smaller the lesion and the more gradualits production or increase, the more insignificant will be the primary changesand, as a matter of fact, true regurgitation may be either temporary orpermanent, so free as to abolish the murmur in weakened hearts when thestasis pressure within the left auricle may actually block the regurgitationmechanically, or so slight or fully met by slight adaptive hypertrophy as forlong periods to add little to the burden of the chambers and present almostnothing in the way of physical signs save the murmur itself. Variations in Quality, Pitch and Duration of Murmur.—The quality, pitchand duration of the murmur will vary with the auricular vigor and capacity and Ist Sd stSd. Fig. 364.—Compare this area, obtained by flat-finger percussion, with the roentgenographirsilhouettes, which represent very .closely the outlines obtainable by modern methods. yet more with right and left ventricular heart strength and intraventricular headof pressure. The size and shape of the opening, abnormalities of consistence and sur-face, the exact nature of the structures chiefly implicated in the valvular ormyocardial disease-process, and the condition of the lungs are one and allimportant factors. A few general deductions are permissible if their limitation and fallibilityare recognized and held in mind. If decided signs of stasis are absent and only the signs of a mitral leakagepresent, a short murmur usually indicates a small leakage; a long one a largerleakage though pitch is-also a factor. In general the greater the degree ofleft ventricular hypertrophy, the larger the leak. A decided heave over the epigastrium usua
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1922
