Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Con-sequently, the recognition of these signs in this area alone wouldnot be so suspicious as was the detection, in my case, of these pal-patory phenomena in two separate and distinct situations. Percussion.—Cardiac dulness is increased over the right auri-cle—that is, at the right of the sternum—but this is not distinctive, since it occurs likewise in mi-tral disease (Fig. 74). Intricuspid stenosis it is likelyto be particularly well marked
Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Con-sequently, the recognition of these signs in this area alone wouldnot be so suspicious as was the detection, in my case, of these pal-patory phenomena in two separate and distinct situations. Percussion.—Cardiac dulness is increased over the right auri-cle—that is, at the right of the sternum—but this is not distinctive, since it occurs likewise in mi-tral disease (Fig. 74). Intricuspid stenosis it is likelyto be particularly well may be said, therefore, thatthe evidence derived by per-cussion is valuable, but notpositive. Auscultation. — Unfortu-nately the results of this meansof examination are also likelyto be very indefinite. Even ifa murmur generated at thetricuspid orifice exists, it islikely to be confused with orindistinguishable from mur-murs produced elsewhere, par-ticularly mitral bruits. In my case, as in Broadbents (ISTo. 15 ofHerricks series), there was a distinctive murmur in the tricuspidarea. In my patient a presystolic murmur existed in the very. Pig. 74.—Kelative Cardiac Dulness in aTypical Case of Tricuspid Stenosis. TRICUSPID STKNOSIS 363 situation in which the thrill was detected, and if was much shorterthai! that at the mitral area, was of a somewhat different pitch,and terminated in a sharp thud, the same as in Broadbents this was not all; when the stethoscope was passed, little by lit-tle, from the long-, rolling mitral bruit towards the ensiform, it wasnoted that there was a space in which the mitral murmur becamelost, while a trifle nearer the sternum another area was reachedin which another and shorter presystolic murmur became fact showed plainly that there were two areas of maximumintensity for these two presystolic murmurs, which fact convincedme that I had to do with two entirely separate and distinct bruits. It may be objected that this
Size: 1395px × 1791px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, bookpublishern, booksubjectheart
