Diseases of the chest and the principles of physical diagnosis . te aortic insufficiency with a Flint murmur. But inthe latter case left ventricular hj^pertrophy is greater, the blood-pressurepicture is quite characteristic, and other pulsatory phenomena such as acapillary pulse, Duroziezs murmur, etc., will establish the diagnosis. The difficulty so many students have in recognizing or even beingable to identify presystolic murmurs is due to the fact that they expect 238 THE EXAMINATION OF CIRCULATORY SYSTEM to hear a swishing sound similar to that produced by systohc or diastoUcmurmurs. The
Diseases of the chest and the principles of physical diagnosis . te aortic insufficiency with a Flint murmur. But inthe latter case left ventricular hj^pertrophy is greater, the blood-pressurepicture is quite characteristic, and other pulsatory phenomena such as acapillary pulse, Duroziezs murmur, etc., will establish the diagnosis. The difficulty so many students have in recognizing or even beingable to identify presystolic murmurs is due to the fact that they expect 238 THE EXAMINATION OF CIRCULATORY SYSTEM to hear a swishing sound similar to that produced by systohc or diastoUcmurmurs. The presvstoHc murmur is a sound very different in is a rumble somewhat Uke a short roll on the drum, which precedes andgradually merges into the first sound of the heart. When the heart becomes dilated and the auricle paralyzed the mur-mur disappears, and fibrillation of the auricle makes its appearance. Thecrescendo quality while clinically characteristic has been shown to be due,not to an inherent quality of the murnnu- but chiefly to the proximity of. Fig. 197.—Mitral ixsufficiexcy. The mitral curtains are thickened, and are the seatofnumerous vegetations. Some of the chordae tendinese are ruptured, all of them arethickened and shortened. The left ventricle is hypertrophied. The murmur of mitralinsufficiency is systolic in time. It is transmitted toward the left axilla and scapula* inreverse of the direction of the blood stream by the papillary muscles and the chordae ten-dinese. The arrow indicates the direction of the regurgitant blood stream. the first heart sound. If the auricle goes into a state of fibrillation or ifit loses its contractile force because of extreme dilatation, the presystolicmurmur disappears and instead of it a murmur is heard earlj^ in presystolic murmurs can arise only at the auriculo-ventricular ori-fices. Phonetic equivalent: R-R-R-upp, Dupp (presystolic rumble);Rup-Tut-Rarou (mid-diastolic rumble) (see Fig. 202). 5. The syst
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1920
