Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Mitral pre-systolic murmur. Apex of heart. Murmurs Made at the Mitral Orifice. Mitral Pre-systolic Murmurs.—The point of maximum intensityis slightly to the right of the apex of the heart (left AUSCULTATION. 305 ventricle) 7 whether it is in the normal position or dis-placed, and its area of diffusion is, as a rule, veryslightly beyond the region of the apex. (Fig. 62.)The localization of a murmur at the region of the apexof the left ventricle is due (a.) to the direction of
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Mitral pre-systolic murmur. Apex of heart. Murmurs Made at the Mitral Orifice. Mitral Pre-systolic Murmurs.—The point of maximum intensityis slightly to the right of the apex of the heart (left AUSCULTATION. 305 ventricle) 7 whether it is in the normal position or dis-placed, and its area of diffusion is, as a rule, veryslightly beyond the region of the apex. (Fig. 62.)The localization of a murmur at the region of the apexof the left ventricle is due (a.) to the direction of thevibrating blood current, which is concentrated at theapex by the valves of the narrowed orifice, (b) Theflaccid condition of the overlying right ventricle pre- Fig. Mitral obstruction. Large arrow direction of current of blood. vents the transmission of the vibrations to the surfaceIn that direction, (c) The left ventricle being also in astate of relaxation and at its greatest distance from thechest wall, the vibrations, conducted to the surfacethrough the overlying lung, influence a very small areaof chest. (Fig. 63.) m A wider area of diffusion of the pre-systohc mitralmurmur is generally due either to unusually close rela- 20 306 THE CIRCULATORY SYSTEM. tion of the apex of the left ventricle to the chest wall, orto increased power of conduction on the part of the tis-sues surrounding the apex of the heart, or to thecharacter of the vibrations. The pre-systolic murmur heard at the apex is gener-ally due to obstruction at the mitral orifice, althoughmurmurs with this rhythm and localization without Fig. 64.
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