Diseases of the chest and the principles of physical diagnosis . Fig. 204.—Illustrating the direction of blood flow in mitral obstruction. 244 THE EXAMINATION OF CIRCULATORY SYSTEM f All these rules are subject to exceptions due to cardiac displacement,etc. Murmurs themselves are variable and often multiple and compU-cated bv pericardial or respiratory sounds. Occasionally murmurs are Fig. 205.—The right heart and tributary bi^uod channels. Pulsation isreadily transmitted to the liver either (1) directly from the right ventricle or
Diseases of the chest and the principles of physical diagnosis . Fig. 204.—Illustrating the direction of blood flow in mitral obstruction. 244 THE EXAMINATION OF CIRCULATORY SYSTEM f All these rules are subject to exceptions due to cardiac displacement,etc. Murmurs themselves are variable and often multiple and compU-cated bv pericardial or respiratory sounds. Occasionally murmurs are Fig. 205.—The right heart and tributary bi^uod channels. Pulsation isreadily transmitted to the liver either (1) directly from the right ventricle or (2) indirectly, asthe result of tricuspid regurgitation, the inferior vena cava being short. In the latterinstances the pulsation instead of being more or less localized to the epigastrium is generaland expansile in character. The liver shows sphygmographically a positive venous pulse. The blood pathway from the jugular veins into the right auricle is also a very directone, hence jugular tracings (phlebograms) readily depict pressure changes in the auricle,especially when the subject is recumbent and gravity assists in the stasis of venous , right bronchus; , right pulmonary artery; , bronchial lymph node;, left auricle; , inferior vena cava; , superior vena cava; , rightauricular appendage; , right auricle; , anterior tricuspid leaflet; , venaazygos ma
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