. Medical diagnosis for the student and practitioner. ery clear anddistinct, as soft as the faintest pulmonary vesicular murmur, or wholly absent. Time.—Distinctly diastolic; beginning at the exact time that the second soundends, with no detectable break, yet often tending, apparently, to obscure, modify,or displace the second sound of the heart in the aortic area, first right interspace,right half of the manubrium stemi and the carotid artery, if this second soundbe shortened, diminished, or, wholly lost, by reason of the peculiarities ofvalvular defects. It is usually accompanied by a systol
. Medical diagnosis for the student and practitioner. ery clear anddistinct, as soft as the faintest pulmonary vesicular murmur, or wholly absent. Time.—Distinctly diastolic; beginning at the exact time that the second soundends, with no detectable break, yet often tending, apparently, to obscure, modify,or displace the second sound of the heart in the aortic area, first right interspace,right half of the manubrium stemi and the carotid artery, if this second soundbe shortened, diminished, or, wholly lost, by reason of the peculiarities ofvalvular defects. It is usually accompanied by a systolic murmur, maximal in the second AORTIC INSUFFICIENCY 70Q right interspace near the sternum or one interspace higher, and transmittedupward into the carotids. In the case of loud murmurs this makes the twosounds resemble more or less closely the to-and-fro sound of the woodsaw (see-saw murmur). Alternative Areas of Maximal Audibility.—These lie along a line joining thechief points of maximal murmur transmission, viz., (a) the second right inter-. Fig. 383.—Graphic representation of murmur. Two varieties of .aortic diastolic mur-mur. (With sphygmogram.) The heart is shown in diastole, aortic leakage beingevident. The blood has just been projected into the aorta and pulmonary arteryby the ventricular contraction. The pulmonary valve tightly closed maintains theblood column, but through the leaky aortic valve a regurgitant current meets thestream descending from above through the open mitral valve. Results.—A diastolicmurmur, dilatation and hypertrophy of left ventricle, a slapping, low-tension Mitral valve, tv. Tricuspid valve, av. Aortic valve, pv. Pulmonary valve. auricle. RA. Right auricle. LV. Left ventricle. RV. Right ventricle. cava superior. VCI. Vena cava inferior. PVn. Pulmonary veins. PA Pulmonaryartery. AO. Aorta. space at the edge of the sternum; (b) the third left interspace-or, (c) midway on aline joining these points; (d) at the
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1922
