. Diseases of the heart and thoracic aorta. rcible than in healthand in many cases the front wall of the chest is forcibly raisedup, as it were, en masse. The contraction of the organ, andtherefore the impulse, are often more deliberate than in double impulse or shock is sometimes perceptible, the firstand chief impulse corresponding to the systole of the ventricle,the second and weaker impulse to the closure of the aorticsegments and to the cardiac rebound. The prsecordial region is, in some cases (more especially inchildren and young persons in whom the chest-wall is softand yieldin
. Diseases of the heart and thoracic aorta. rcible than in healthand in many cases the front wall of the chest is forcibly raisedup, as it were, en masse. The contraction of the organ, andtherefore the impulse, are often more deliberate than in double impulse or shock is sometimes perceptible, the firstand chief impulse corresponding to the systole of the ventricle,the second and weaker impulse to the closure of the aorticsegments and to the cardiac rebound. The prsecordial region is, in some cases (more especially inchildren and young persons in whom the chest-wall is softand yielding), more prominent than in health. P P 594 Diseases of the Heart. The areas of cardiac dulness, both superficial and deepare increased, and the percussion resistance is greater than inhealth. In hypertrophy of the left ventricle the cardiacdulness is increased in the vertical, and to some extentalso in the transverse directions, for the hypertrophy isusually, as I have previously pointed out, associated withsome dilatation. (See fig. 246.). Fig. 246.—Hypertrophy of the left ventricle, showing the altered position of the apex.—(After von Diisch.) The continuous line represents the normal heart ; the dotted line the hj-per-trophied left ventricle. The apex of the left ventricle is outside the dotted linea b, which is drawn through the left nipple. PJiysical signs of HypertropJiy of the L eft Ventrielc. 595 The character of the Jieart sounds depends more parti-cularly upon the nature of the primary lesion. When thehypertrophy depends upon extra-cardiac conditions, whenthere is no valvular disease, and when the heart is (except-ing the hypertrophy of the left ventricle) otherwise healthy,the impulse of the hypertrophied heart can sometimes beheard against the chest-wall as a jar or click; the firstsound is usually more prolonged, more muffled and dullerthan in health, and not unfrequently reduplicated ; whenthe hypertrophy is combined with dilatation, the first soundis, on
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectheart, bookyear1884
