. Physical diagnosis . Systolic Mitral Murmur Replacing the First Sound of the Heart. first sound of the heart may or may not be replaced by the murmur(see Fig. 123). When the sound persists and is heard either withor before the murmur, one can infer that the lesion is relativelyslight in comparison with cases in which the first sound is wholly VALVULAR LESIONS. 215 obliterated. Post-systolic or late systolic murmurs, which are occa-sionally heard in mitral regurgitation, are said to point to a rela-tively slight amount of disease in the valve (see Fig. 122). Rosen- lst L 1st 2nd 2nd Fig. 124.
. Physical diagnosis . Systolic Mitral Murmur Replacing the First Sound of the Heart. first sound of the heart may or may not be replaced by the murmur(see Fig. 123). When the sound persists and is heard either withor before the murmur, one can infer that the lesion is relativelyslight in comparison with cases in which the first sound is wholly VALVULAR LESIONS. 215 obliterated. Post-systolic or late systolic murmurs, which are occa-sionally heard in mitral regurgitation, are said to point to a rela-tively slight amount of disease in the valve (see Fig. 122). Rosen- lst L 1st 2nd 2nd Fig. 124.âLate Systolic Murmur. The first sound is clear and an interval intervenes between it and the murmur. bach claims that the late systolic murmur is always due to organicdisease of the valves and never occurs as a functional murmur. When compensation fails, the murmur may altogether disappearfor a time, and if the patient is then seen for the first time anddies without rallying under treatment, it may be impossible to. Pulmonic secondaccented. Systolic murmurloudest here. Fig. 125.âMitral Regurgitation. The murmur is heard over the shaded area as well as in the back. make the diagnosis. The very worst cases, then, are those in whichthere is no murmur at all. The murmur of mitral regurgitation is conducted in all directions,but especially toward the axilla and to the back (not around thechest, but directly). In the latter situation it is usually louder 216 PHYSICAL DIAGNOSIS. than it is in mid-axilla, and occasionally it is heard as loudly in theback as anywhere else. This is no doubt owing to the position ofthe left auricle (see Figs. 125 and 126). (b) After compensation is established and as long as it lasts anaccentuation of the pulmonic second sound is almost invariably tobe made out, and may be so marked that we can feel and see it, aswell as hear it. Not infrequently one can also see and feel thepulsation of the conus arteriosusânot the left auricleâin the secondand thir
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