Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Mitral systolic. mitral obstruction have been heard in aortic regurgita-tion (Flint murmur), in aortic obstruction and withadherent pericardium. Mitral Systolic Murmurs.—The point of maxi-mum intensity is at or close to the apex. The area ofdiffusion extends also around this point, and to the leftbeyond the prsecordia into the axillary region. () The murmur is also heard in the back, the point AUSCULTATION. 307 of maximum intensity being in the left interscapularspace,
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Mitral systolic. mitral obstruction have been heard in aortic regurgita-tion (Flint murmur), in aortic obstruction and withadherent pericardium. Mitral Systolic Murmurs.—The point of maxi-mum intensity is at or close to the apex. The area ofdiffusion extends also around this point, and to the leftbeyond the prsecordia into the axillary region. () The murmur is also heard in the back, the point AUSCULTATION. 307 of maximum intensity being in the left interscapularspace, a little above the angle of the scapula, oppositethe spines of the fifth and sixth dorsal vertebra?. () The area of diffusion is usually limited to the leftscapular and interscapular regions. Fig. Mitral systolic. The murmur made at the mitral valve (situatedbehind the left half of the sternum at the level of thefourth costal articulation) reaches the surface in frontover the apex of the heart and behind in the scapular re-gion by two different lines of conduction. (Tig. 66.) 308 THE CIRCULATORY SYSTEM. Conduction to the apex is mainly by the tissues of theleft ventricle, which at the time of the first sound of theheart are in a state of extreme tension. The vibrationsmade by the regurgitant stream are transmitted (a) bythe leaflets of the mitral valve through the tense chordseatendinese and papillary muscle to the apex of the leftventricle, (b) The apex of the left ventricle at this Fig. 66.
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