Diseases of the chest and the principles of physical diagnosis . 4 of which were autopsiedand the remainder were clinical observations. Recenth Stoddard^ hasadded 22 additional cases. A case of aneurismal dilatation of the has been Ieported by ^ Hypertrophy with or without dilatation of the right ventricle isa constant finding in adult cases. 1 Univ. Pa. Med. Bull., December, 1910. 2 ji^rch. Int. Med., July, 1915.^Proc. Path. Soc. xix, 1917. 762 DISEASES OF THE PERICARDIUM, HEART, AND AORTA Symptoms and Physical Signs.—In uncomplicated cases the symptomsare, as a ru
Diseases of the chest and the principles of physical diagnosis . 4 of which were autopsiedand the remainder were clinical observations. Recenth Stoddard^ hasadded 22 additional cases. A case of aneurismal dilatation of the has been Ieported by ^ Hypertrophy with or without dilatation of the right ventricle isa constant finding in adult cases. 1 Univ. Pa. Med. Bull., December, 1910. 2 ji^rch. Int. Med., July, 1915.^Proc. Path. Soc. xix, 1917. 762 DISEASES OF THE PERICARDIUM, HEART, AND AORTA Symptoms and Physical Signs.—In uncomplicated cases the symptomsare, as a rule, not striking, and may be wanting entirely. Cyanosisand clubbing of the fingers, so commonly seen in other congenital affec-tions, are unusual. Dyspnea and palpitation on exertion may occur. The diagnosis depends, almost entirely, on the physical signs, ofwhich the murmur is the most important. The murmur is producedby the rush of blood through the duct from the aorta to the pulmonaryartery. Its point of maximum intensity is in the second left Fig. 412.—Patent ductus arteriosus. Transposition of the aorta and the pulmonaryartery; patent ductus arteriosus; hypertrophy of the right ventricle. Patent foramenovale; artial atelectasis of the right lung; general visceral congestion. (.A. G. Ellis.) The murmur is usually loud, harsh, and of a churning or rasping in the case of imperforate ventricular septum the murmur is very longbeginning in systole and continuing into diastole. It may be loudest atits commencement and gradually diminish or it may gradually becomeintense at the middle period and then wane. In other instances the mur-mur may be double or while continuous may have a systolic and a dias-tolic accentuation. The second pulmonic sound is usually much accen- CONGENITAL HEART DISEASE 763
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