A medical handbook : for the use of practitioners and students / by R.S. Aitchison.

Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: A medical handbook : for the use of practitioners and students / by R.S. Aitchison. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    diminished in its intensity as the stethoscope is carried down the left edge of the sternum, where the feeble diastolic murmur may now be heard. If the incompetence be greater than the stenosis no systolic murmur may be heard in the aortic area, but the diastolic may be heard and propagated loudly down the left edge of the sternum and to the ensiform cartilage. It is also heard in the carotid artery, along with a systolic, cai pressure being made upon it with the stethoscope —if the incompetence be great (Fig. 7). It is well to note that the absence of the second sound does not indicate that the valves are er.tirely gone, but simply that there may be diminished elasticity, and hence no accentuated sound. The secondary effects in the later stages, when the mitral valve becomes incompetent, have already been described. Pulmonary stenosis and incompetence are extremely rare, and then generally congenital. If murmurs exist, they are best heard in the pulmonary area, and if a diastolic murmur be present it may be propagated, like the aortic diastolic, down the left edge of the sternum, but it would be accompanied by signs of dilatation of the right ventricle, with tricuspid incompetence, &c.—the signs of aortic disease being absent. Method of Auscultation of the Valves.* —Place the stethoscope on the mitral area, and concentrate the attention upon the first sound of the heart, with a finger upon the carotid artery if necessary. j ^ Tf (i) Is there a murmur immediately preceding the first sound it so, it is presystolic, and it may originate at the mitral or tricuspid valve. Compare the mitral and tricuspid areas for the maximum intensity. (Mitral or tricuspid stenosis, the latter being extremely ^^(2) Ts there a murmur synchronous with or replacing the first sound? If so, it is systolic, and it may be produced at any of the four valves. (Mitral or tricuspid regurgitation; aortic or pulmonary stenosis, the latter being very rare.) ■, , • -a (3) Examine, in rotation, the left auricular area, and the tricuspid, aortic and pulmonaiy areas to find the position of maximum inten- sity, and trace the direction of propagation of the murmur or murmurs. , , , ... A Mitral systolic murmurs are heard best at the mitral area isometimes also at the left auricular area), and are propagated from the apex round towards the left axillary line. , . , . ., B. Tricuspid systolic murmurs are heard loudest m the tricuspid area, and are propagated over the liver. Compare A with h. C Aortic systoHc murmurs are heard at the aortic area, and are o]wi;ated by the carotid artery. They diminish in intensity as iiri> * Tliis method only relates to the systematic examination of the murmurs, and the e ul^of the ex'Lmination should be considered alo,^ with the signs .and symptoms already described. Murmurs are not .nvaruably propagated m the i'nefof the blood current. They are due to the v.brat.pns 'l'^ ■;;™<'^' ^ structures, and, therefore, they may somctunes vary in pitch and intensity, and yet have a common origin. Aortic regurgitant murmurs are often best heard in c-xrdiac areas other than those usually stated.