Diseases of the chest and the principles of physical diagnosis . nary artery, are best heard at the pulmonic area. They aresoft and blowing, low in pitch, variable in character, indefinite in trans-mission. Murmurs are also described as being crescendo or diminuendoin character, the terms being used in the musical sense to indicate acontinuous increase or decrease respectively of their intensity. Themurmur of mitral stenosis is often typically crescendo, that of aorticinsufficiency often diminuendo, in quality. 232 THE EXAMINATION OF CIRCULATORY SYSTEM Even organic murmurs may be variable in q
Diseases of the chest and the principles of physical diagnosis . nary artery, are best heard at the pulmonic area. They aresoft and blowing, low in pitch, variable in character, indefinite in trans-mission. Murmurs are also described as being crescendo or diminuendoin character, the terms being used in the musical sense to indicate acontinuous increase or decrease respectively of their intensity. Themurmur of mitral stenosis is often typically crescendo, that of aorticinsufficiency often diminuendo, in quality. 232 THE EXAMINATION OF CIRCULATORY SYSTEM Even organic murmurs may be variable in quality and iiitensityto the point of actual disappearance, either constantly or intermittentlyin a series of successive cardiac cycles. Such variation is not uncommonin auricular fibrillation, extrasystole and heart block owing to variabledegrees of auriculo-ventricular coordination and rate of blood flow. Withthe onset of auricular fibrillation or of paroxysmal tachycardia, murmursoften • disappear entirely, to return when the normal rhythm Fig. 189.—Aortic obstkuction. The aortic leaflets are fused together as the result ofinflammatory adhesion, leaving only a small elliptical opening. The arrow indicates thedirection of blood flow. The physical signs of aortic obstruction are a systolic thrill and aloud crescendo murmur at the base of the heart, the latter being transmitted into thecarotid arteries. The pulse is small in volume and the systolic plateau shows a long, slow,gradual ascent and descent. The left ventricle becomes greatly hypertrophied and hence the cardiac impulse is dis-placed downward and outward, and the longitudinal diameter of the heart is increasedWhen, as is usually the case, mitral insufficiency exists, the vertical diameter is also in-creased. (See Fig. 172.) INDIVIDUAL VALVULAR MURMURS 1. The systolic aortic murmur results from roughening or obstructionat the aortic orifice, or dilatation of the aorta. It is best he^ard at thesecon
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