Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Tricuspid obstruction. Tricuspid Systotjc Murmurs.—The point of maxi-mum intensity is at the base of the ensiform cartilage,and the area of diffusion from the point of maximumintensity is upward and to the right, not above the thirdrib, and to the left toward the apex of the heart, () Conduction of the murmur in these two direc-tions is by the regurgitant stream, and by transmission 314 THE CIRCULATORY SYSTEM. through chordae tendinese to apex, the same is in. mitralre
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Tricuspid obstruction. Tricuspid Systotjc Murmurs.—The point of maxi-mum intensity is at the base of the ensiform cartilage,and the area of diffusion from the point of maximumintensity is upward and to the right, not above the thirdrib, and to the left toward the apex of the heart, () Conduction of the murmur in these two direc-tions is by the regurgitant stream, and by transmission 314 THE CIRCULATORY SYSTEM. through chordae tendinese to apex, the same is in. mitralregurgitation. Vibrations made at the valve are carried by theregurgitant current of blood upward into the auricleover which the murmur is heard. The vibrations aretransmitted to the right ventricular wall by the attach-ment of the valve and by the tense chordse tendinere and Fig. Tricuspid regurgitant. papillary muscle. The point of maximum intensity andthe area of diffusion vary according to the degree ofhypertrophy and dilatation. At times the murmur cor-responds in location to the mitral area. It is rarelyheard beyond the praecordia, and is not carried into theaxilla nor heard behind in the scapular region. Eegurgitation at the tricuspid orifice results from AUSCULTATION. 315 insufficiency due to (a) the effects of acute and chronicendocarditis, to vegetations, to induration or distortionof the valves, and to shortening of the chordae tendineae;(b) from dilatation of the right ventricle and tricuspidring, with relative insufficiency. The dilatation may bepermanent or transient (safety-valve action). (See Re-gurgitation at Tricuspid Orifice.) Fig. 72.
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