. Diseases of the heart and thoracic aorta. cy, as follows : (i.) Transmitted pulsation from the heart.—This form ofpulsation is generally due to enlargement (hypertrophy anddilatation) of the right ventricle, but it may also be causedby the downward displacement,of the organ, which is seen inpulmonary emphysema,^ aneurism of the arch of the aorta, In emphysema the right side of the heart is dilated and hypertrophied, andto this cause the epigastric pulsation, which is so marked a feature in emphysema,is in part due. H 114 Diseases of the Heart. collapse of the abdominal viscera, etc. The puls
. Diseases of the heart and thoracic aorta. cy, as follows : (i.) Transmitted pulsation from the heart.—This form ofpulsation is generally due to enlargement (hypertrophy anddilatation) of the right ventricle, but it may also be causedby the downward displacement,of the organ, which is seen inpulmonary emphysema,^ aneurism of the arch of the aorta, In emphysema the right side of the heart is dilated and hypertrophied, andto this cause the epigastric pulsation, which is so marked a feature in emphysema,is in part due. H 114 Diseases of the Heart. collapse of the abdominal viscera, etc. The pulsation is inthese cases exactly synchronous with the ventricular contrac-tion, and is often transmitted through the left lobe of the liver.(2.) Pulsation of the abdoniinai aorta.—In some of thesecases, as for instance in neurotic pulsation of the vessel, theaortic pulsation may be directly felt, in others it is indirectlyfelt, and is communicated through the liver or some solidbody, such as a cancer of the pylorus, lying in front of the. Fig. 31.—Hypertrophy of the left ventricle, shelving the altered position of the apex.(After von Dusch.) The continuous line represents the normal heart; the dotted line the hyper-trophied left ventricle. The apex of the left ventricle is outside the dotted linea b, which is drawn through the left nipple. Displacement of tJie apex-beat. 115 vessel. The pulsation in this form is a little behind (after)the apex beat, but this fact is sometimes with difficultyestablished in practice. (3.) Aneiirism of the lozver part of the thoracic, or of theupper part of the abdominal —This is not a commoncause of epigastric pulsation. The aneurismal pulsation may-be directly felt, or may be transmitted through the liver. According to Sibson, the epigastric pulsation, which iscaused by an aneurism of the lower part of the thoracic or
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