. Internal medicine; a work for the practicing physician on diagnosis and treatment, with a complete Desk index. are progressively developed. Physical Signs.—Inspection shows, as a rule, a heaving impulse dueto the left ventricle hypertrophy, situated at the normal place or slightlyto the left. As compensation fails and dilatation of the left and later ofthe right ventricle takes place, the impulse is displaced beyond the mid-clavicular line. A distinct thrill corresponding in time and duration to the systolic murmurmay be detected at thesternal border or at theright side of the rootof the nec
. Internal medicine; a work for the practicing physician on diagnosis and treatment, with a complete Desk index. are progressively developed. Physical Signs.—Inspection shows, as a rule, a heaving impulse dueto the left ventricle hypertrophy, situated at the normal place or slightlyto the left. As compensation fails and dilatation of the left and later ofthe right ventricle takes place, the impulse is displaced beyond the mid-clavicular line. A distinct thrill corresponding in time and duration to the systolic murmurmay be detected at thesternal border or at theright side of the rootof the neck over thecarotid. The pulse issomewhat retarded. Inother respects, namely,as to volume and tension, it often preserves its normal characters, though instenosis of high grade it may be small and slow, with the filling of thearteries well maintained between the beats. The sphygmogram shows aslow rise, a broad summit, and a slow decline. There is in most of the casesin advanced hfe evidence of marked arteriosclerosis. Upon palpation theposition of the apex beat may be obscured by pericardial adhesions or an. Fig. 350.—Aortic stenosis; radial tracing. Aoirrrc stenosis. 653 emphysonialoiis lurifj. Upon pcnussion while compensation is still inuiri-tained, the transv( (liainctcr of the al)S(jluto and that of tlieiclativo dulnoss of the lieart an; littk; if at all increased. Auscultationdiscloses in the second rif2;ht intercostal space at the sternal border a verydistinct systolic niurinvu*, usually coarse and harsh. This murmur is amongthe loudest of the heart murmurs and may soraetimcs he heard at a distanceof some feet from the j^aticnt. Not infi-eciucritly it has a musical qualityduring some part of its course. It is distinctly transmitted to the carotidsand subclavians, especially upon the right side; less plainly over the heart,but in some cases it may be heard at the apex. Very characteristic is theabsence of the second aortic sound. A second sound heai-d at t
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectmedicine, bookyear192
