This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1917 Excerpt: ...represent either: (a) mitral reflux, maximal at the apex; or, (b) aortic stenosis, maximal at the base. The former, if endocarditic not "relative," or "accidental," is usually clear and distinct unless the ventricle is very weak or a mitral stenosis co-exists and dominates it or blocks the back flow of a weakened ...
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This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1917 Excerpt: ...represent either: (a) mitral reflux, maximal at the apex; or, (b) aortic stenosis, maximal at the base. The former, if endocarditic not "relative," or "accidental," is usually clear and distinct unless the ventricle is very weak or a mitral stenosis co-exists and dominates it or blocks the back flow of a weakened ventricle by the extreme volume pressure of afibrillating widely dilated paralytic auricle. Helpful Suggestions with Respect to Systolic Murmurs.--In the absence of evidence of concurrent mitral stenosis or excessive left auricular dilatation a relatively soft and low-pitched murmur, not typically transmitted, but maximal at the apex, is likely to be due to relative mitral insufficiency rather than to mitral endocarditic valvular disease. The true typical systolic murmur of aortic stenosis is transmitted above the right base of the heart to the vessels of the neck and usually associated with a relative diminution or total loss of the second aortic sound and a more or less characteristic pulse effect. Common Diastolic Bruits.--If the murmurs heard are diastolic in time, the assumption is that any homogeneous murmur, maximal at the third left interspace, ensiform, or the right second interspace, transmitted chiefly along the lines indicated, and, if loud, usually heard in the right carotid or in both is caused by aortic regurgitation. This assumption is confirmed if we find even a modified water-hammer pulse ("pulsus cekr," "Corrigan pulse"), and a high "pulse pressure," in the absence of signs of marked hyperthyroidism (Parry's disease, Graves' disease, exophthalmic goiter) and, in the presence of the diastolic murmur, is a sound one to rest upon even if hyperthyroidism is present. If an audible dias...
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