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RM2AXK7E3–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . ur and established the ex-istence of mitral regurgita-tion. The aortic systolic bruitand loss of the aortic secondsound, together with the sys-tolic thrill, gave evidence ofstiffness, and perhaps steno-sis of the aortic valves. The absence of a rheumatic history, thepatients age, the late development of symptoms, the moderatearteriosclerosis, and lastly, the heart findings, all seemed to war-rant the opinion that the valvular changes were du
RM2AXHW9Y–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 96. Fig. 9? 401
RM2AXK81X–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . eing essentially the same,jo of a grain of strychnine sulphate three times a day was or-dered. As the temperature remained normal and the murmurhad not increased, two days later tincture of digitalis was cau-tiously administered. Withintwenty-four hours the leftventricle had come down 0.5centimetres, and upon thedigitalis being increased, thenext twenty-four hours wit-nessed a still further diminu-tion in the extent of relativecardiac dulnes
RM2AXKCNN–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . if the eroded surface is notat once covered by the deposit of fibrin from the blood, a consid-erable loss of substance may take place. This is far more common,however, in the malignant form, although it has been observed insimple endocarditis complicating rheumatism. More commonlythe eroded surface, necrotic from the action of bacteria, is at oncecovered by a deposit of fibrin from the blood. This fibrin forms afirm warty mass of a yellowish
RM2AXHF0A–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . *S Figs. 113, 114.—Showing External Toiour in Case of Aortic Aneurysm(see Fig. 115). necessitate the wearing of a metal shield, lest the tumour be acci-dentally struck and caused to burst. Figs. 113-115 show ananeurysm in this location which had an external diameter ofseveral inches. I vividly recall another man sent to me by Dr. G.Frank Lydston, who presented a pulsating prominence which oc-cupied the entire prsecordia, extending from one
RM2AXHGW9–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . ngs from the ascending or transverse arch and hasattained great size. I recall a man whom I treated for monthsfor aortic regurgitation without suspecting the existence of ananeurysm until quite suddenly signs of pressure on the left lungarose. Even then other signs of the aneurysm were not at all dis-tinct, yet were of such a kind as to render its presence certain. Other effects of aortic aneurysm than those already mentionedwill be left for
RM2AXJ4FX–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . s of the thumbsare then gently pressed togetherin front of the abdomen, and,a proper degree of resistancebeing offered, they are thus slowlyraised until the hands rest on thetop of the bead, after which theyare slowly lowered to the originalposition (Figs. 86 and 87). (6) The arms, depending atthe sides, are then elevated for-ward and upward without bend-ing them until thev are held alofton a line with the perpendicularaxis of the body. They
RM2AXJ41R–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 85..
RM2AXJFW0–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . e myocardium ishealthy and compensatory hy-pertrophy is maintained thepulse is regular, and in rate is generally somewhat below the nor-mal. Accordingly, an undue acceleration, or an irregularity, orintermittence of the pulse is a sign of weakness. If aortic incom-petence is associated the pulse is likely to be modified in accord-ance with the characters of that lesion. The sphygmographic tracing of aortic stenosisshows rather distinctive ch
RM2AXHERF–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . rysmsof the transverse arch of the type now considered. If the tube isbut slightly constricted, the lung becomes retracted only sufficientlyto occasion immobility of the side, tympanitic resonance and di-minished respiratory sounds. When the bronchus is greatly nar-rowed the side becomes perceptibly smaller than its fellow, thepercussion note is dull, and respiratory sounds are abolished.There may be retention of the secretions with rales, b
RM2AXJB5B–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . is usually open, and the interventricular sseptum issometimes incomplete. The pulmonary artery is always nar-rowed, and there may be atresia of this vessel. The ductus arterio-sus is generally open, yet is in some cases found closed. Veryrarely the stenosis is caused by constriction of the right conusarteriosus, in which event this may appear like a third ventricle,and both the interventricular and interauricular septa are defect-ive, the pu
RM2AG0YDB–. Heart disease, with special reference to prognosis and treatment. e transmitted. The pulsus bisferiens is sometimes met with in aorticincompetence, more commonly when there is concomitant AORTIC 1NC0MPETEACE. 14 3. stenosis. It is a peculiar double beat, best felt when thefingers exert a moderate pressure on the artery, less than isnecessary to bring out fully the collapsing character of thepulse, but more than is employed to appreciate dichrotism.It can be readily demonstrated by the spyhginograph. It isproduced by a double systolic effort, which can sometimesbe felt or heard in the heart i
RM2AXHAR1–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 126.—Initial High-Tension Pulse, from a Man, Aged Forty-eight, with Ar-teriosclerosis and a Small Aneurysm of the Arch of the Aorta. arteriosclerosis, aneurysms of the aorta, and chronic interstitialnephritis, typical tracings of which are given (Figs. 126 and127).. Fig. 127.—Sustained High-Tension Pulse from a Woman, Aged Sixty-three, withChronic Interstitial Nephritis. The following sphygmogram (Fig. 128) may be considered asfairly re
RM2AXHK65–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . considerable size does not nec-essarily preclude the possibility of long life and may not giverise to symptoms. Duroziez, cited by Gibson, discovered such acondition in a woman who died of erysipelas at the age of sev-enty-six. When not dependent upon pulmonary stenosis or other valvu-lar defect there may even be an absence of murmur or other ob-jective evidence of the patency. A defect in the interventricular sseptum may also fail tomanifes
RM2AXJBJP–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . bly always present, and when stenosis is com-bined there is also a pulmonic systolic murmur, so that there is adouble or to-and-fro bruit, the same as when there is regurgitationat the aortic orifice. The seat of maximum intensity of this dias-tolic murmur is at the left of the sternum in the second and thirdleft interspaces. Its direction of transmission is downward alongthe left sternal margin, and its quality is soft. Indeed, it may soclo
RM2AXJE1M–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 68.—Ehythm of Aortic Obstructive Murmur. mitral defect, that percussion detects any increase of absolute andrelative cardiac dulness to the right. Auscultation.—The first sound at the apex is apt to bedull and muffled in conse-quence of the preponderanceof its muscular element, whilethe second tone is likely to beenfeebled. Over the base ofthe heart in the aortic areathe ear perceives a murmurwhich is synchronous with thefirst sound, an
RM2AXHYPJ–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 95 Fig. 93. 460.
RM2AXJTW2–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . seems to corroborate the view thatdropsy depends upon the state of the blood and nutrition of thecapillaries, as wrell as upon the degree of capillary and venousengorgement. This patient subsequently succumbed to a thirdattack in the hospital. Mr. B., aged twenty-nine, tailor, consulted me January 9,1900, on account of great breathlessness upon the slightest effort.He gave a history of rheuma-tism four years previous, sincewhich time he had
RM2AXEPWW–Traité des maladies du coeur et des gros vaisseaux . ? ..... J/uvk+i. Jntt>. Util oU »x (aîafiow ? • / /y ri à $£*
RM2AXHJ39–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . beat at least 160 times a minute. (2) The onset and ter- ESSENTIAL PAROXYSMAL TACHYCARDIA 733 ruination of the attack must be so sudden and abrupt as to give itthe character of a paroxysm. Although a pulse-rate of less than100 is frequently observed in persons with some structural diseaseof the heart, still in essential tachycardia the number of cardiaccontractions is often vastly in excess of this number, running ashigh as 200, and in a few
RM2AXJJAH–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . e heart - muscle been notquite healthy and had thatrun started a stretching ofthe aortic ring which had beenincreased by succeeding ef-forts, or had the strain ledto an aortitis or aneurysm,and this to insufficiency of thevalves ? Rupture of a cuspwas out of the question, be-cause of the absence of serioussymptoms in the weeks imme-diately succeeding his run. Aprevious valvulitis was notimpossible, for it is wellknown that the enormous secon
RM2AXJ064–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 95 Fig. 93. 460
RM2AXJDD2–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . e. At all events this case illustrates the influence of right heartlesions in the causation of general venous and visceral stasis, whilethe gangrene bore witness to the profound emptiness of the aorticsystem. Physical Signs.—Inspection.—A perusal of Herricks col-lected cases convinces one that there is nothing in the appearanceof these patients to distinguish them from those with mitral dis-ease in the last stages ofbroken compensation. InCa
RM2AXERT3–Traité des maladies du coeur et des gros vaisseaux . ^c<, -? r% ri. ir. ti# r*îJM«±u4>Jwù </,„;.,/ /m/j. lU/t */f , WaiéUftMl % *
RM2AXHMJR–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . ly or acutely induced, and independent of previous recognis-able myocardial or endocardial disease. Morbid. Anatomy.—By dilatation of the heart is meant anincrease in the capacity of its chambers due to rapid or gradualstretching of its walls. In most cases hypertrophy is combinedwith dilatation and has preceded the development of the latter.A dilated heart is as large or larger than one only hypertrophied,but the muscle is flabby, and the o
RM2AXJD4W–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Con-sequently, the recognition of these signs in this area alone wouldnot be so suspicious as was the detection, in my case, of these pal-patory phenomena in two separate and distinct situations. Percussion.—Cardiac dulness is increased over the right auri-cle—that is, at the right of the sternum—but this is not distinctive, since it occurs likewise in mi-tral disease (Fig. 74). Intricuspid stenosis it is likelyto be particularly well marked
RM2AG0Y11–. Heart disease, with special reference to prognosis and treatment. c mitral murmur, strictly speaking. These varietiesof murmur may be represented diagrammatically as shownin Fig. 11. The disappearance of the second sound at the left of theapex, which, with the short, sharp character of the firstsound, marks the second stage of mitral stenosis, is probablyexplained by the following considerations. In the normal o i94 HEART DISEASE. heart, a second sound is always audible at and to the leftof the apex; and repeated careful examinations have con-vinced me that it is the aortic second sound whic
RM2AXJXXD–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . s term is too restricted, however; since, as is well known,the bruit in some cases commences before the contraction of the auricle, in fact immediatelyafter the second sound, andlasts throughout the longpause. It is consequently adiastolic and not always anauricular systolic murmur,and as such is in contrast tothe systolic one of mitral re-gurgitation. It has also beencalled the mitral directmurmur, because transmittedin the direction of the
RM2AG11KC–. Heart disease, with special reference to prognosis and treatment. , Schott, 92, and appendix , GErtel, 91 for venous obstruction, 108, 183 Tricuspid area, 24 incompetence, 207 stenosis, 209 J. y Vaso-dilators, 111, 136, 160, 206, 238,311 Venesection, 109, 161, 183, 205, 261 Venous stasis, 49, 108, 205, 257 Ventricle, left, 12 , , dilatation of, 239 , , dilatation and hvper- trophy of, 42, 147, 170, 240 , , hypertrophy of, 230, 130 , right, 12 , , dilatation of, 272 , , dilatation and hyper-trophy of, 45, 170, 187, 214, 222,27:4 Vomiting, 49, 161, 259 W Walshe, 27, 51, 68, 301Water-hammer pul
RM2AXJ9E6–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . ering too muchinto detail, it will suffice tostate that he presented theusual symptoms of consump-tion, emaciation, cough, pro-fuse muco-purulent expectora-tion, febrile temperature, anda rapid, feeble pulse, the func-tions of the digestive organsremaining good. There wasno cyanosis. The right apexwas retracted, and expanded poorly upon inspiration. Bothapices showed dulness, bronchial breathing, and moist rales. The prsecordium bulgedfrom t
RM2AXKC14–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . o loss of substance,the portions sloughed off passing into the circulation as septicemboli. The valve-cusp thus ulcerated is naturally weakened, and fre-quently gives way before the pressure of the blood, forming smallpouches in the valve, the so-called valvular aneurysms, or givingway completely perforate the valves. Acute valvular insufficiencycan thus be produced (Fig. 27). A valve-leaflet may becomepartially detached, and the free end sw
RM2AXJJ5J–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 60.—Relative Dulness in Case of Aortic Regurgitation (p. 309). First examination. 312 DISEASES OF THE HEART gitation to exist without discovery. I therefore considered thisexplanation as less likely than one of the others. Regarding aneu-rysm as cause of aortic incompetence, I had already observed acase in which such was the condition, not a very unusual one, butfor the greater part of a year there had been no symptom to point. Fig. 61.
RM2AXK38R–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 40.—Point of Maximum Audibility(shaded) and Area of Transmission(outlined) of Mitral Regurgitant Murmur. MITRAL IMWUIUJITATluN 243 that a shorter or longer presystolic murmur often ushers in thesystolic bruit. It forms but an added element, and in nowisealters the fact stated above—namely, that the time or rhythm ofthe mitral regurgitant murmur is strictly systolic (Fig. 41).. Fig. 41.—Time of Mitral Kegurgitant Murmur.Ked shows time of
RM2AXHRBD–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . ed by thehand against the ankle justabove the instep (Figs. 99 and100). (18) This is a correspondingmovement by the other leg, re-sisted in the same manner. (19) Supporting himself bythe back of a chair the patient FlG 102flexes his thigh at the hip, the leg hanging limp and flexed, while the attendant resists first theupward and then the downward movement (Figs. 101 and 102). (20) This is a similar movement by the opposite thigh. If desired
RM2AXJ8YX–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . e than the right. The aortic valves werefound competent, but the pulmonary valves leaked slowly to thehydrostatic test. Looking into the pulmonary artery from above, it appearedas if a nipple with a small opening at its apex projected into thevessel, and at one side near its base was a second small opening,which was closed in below by a thinner membrane (Fig. 81). Theright ventricle was hypertrophied and dilated, and the right auri-cle was a
RM2AXJ6JC–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . sideof the patients limb which looks in the direction towards which the extremity is to be moved. Itoften conduces to steadiness ofmovement for the assistant toplace his other hand against someother part of the limb or trunkthan that to which resistance isapplied. The following descrip-tion gives the exercises in theorder in which they are usuallyexecuted: (1) The arms are extended in front of the body on a level with the shoulders and with
RM2AXHDPW–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . eatedly proved. Williams finds that certain aneurysmscan be more surely detected by this means than by any other modeof examination. It enables one to determine their location andextent and whether or not the tumour is increasing in size. Final-ly, if the aneurysm is situated at the left, it is best seen frombehind, while those at the right of the heart show best from thefront. Although it is possible for even skilled observers to commiterro
RM2AXJWEA–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . here. Theapex-beat was in the sixth in-terspace, 4^ inches to left ofthe midsternal line, of thecharacter of a faint tap in anarea of diffused impulse (Fig.50). A presystolic thrill ranup to and ended with thisfaint, sharp tap, and therewas marked epigastric pulsa-tion. Relative dulness was in-creased in all diameters, from third interspace to sixth, and from2 inches to right of median line to 5 inches to left of the same.The first sound was
RM2AG1196–. Heart disease, with special reference to prognosis and treatment. f to show position of the valves and septa. (QuainsAnatomy.) a, Innominate and left carotid arteries; b, Transverse part of arch ; c, Vena cava superior;d. Ascending part of arch of aorta; e, Pulmonary artery; f, Pulmonic valves; g, Appen-dix of left auricle; h. Inter-auricular septum; i, Fossa ovalis, with Eustachian valvebelow; j, Left segment of tricuspid valve: k, I ntpr-ventricular septum; I, Left ventricle ;m, Coronary vein; n. Right segment of tricuspid valve ; o, Inferior vena cava; p, Hepaticveins; q, Left ventricle ;
RM2AXK3RF–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . theblood-stream, and are called murmurs. It is plain that many dif-ferent factors influence the character of a murmur, and that ifreliable information is to be derived from the study of a murmur the characters peculiar to eachmust be understood. The auscultatory indica-tion of mitral regurgitation,then, is a systolic murmurheard with maximum inten-sity in the mitral area—i. e.,at or close to the apex-beat(Fig. 40). Such a bruit isnot, howeve
RM2AXHTMJ–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 98. Fig. 99.
RM2AXHPEN–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . ome visible indi-cation of their nature. Palpatiun.—This is of value in the determination of oedemaand of hepatic engorgement even more than in the examinationof the heart. Yet by carefulpalpation of the prsecordiumone is often able to locate anapex-beat which is too feebleto be visible. It may enableone also to perceive that thecardiac impulse has the dif-fused jogging character of dil-atation with hypertrophy, orthe feeble, slapping shock
RM2AXHTAT–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 98. Fig. 99..
RM2AXJJWD–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . AORTIC REGURGITATION .,:, only in the fourth left interspace, close to the breastbone. It: isgenerally most distinct in the erecl position or when the heartsaction is excited. Neverthe-less I have certainly observedcases in which the murmur be-came more distinct and easilyrecognised when the patientwas recumbent. This murmuris transmitted downward to-wards the ensiform appendix,and in some instances alsotowards the left, even as faras the ap
RM2AXJ2PN–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 87..
RM2AXHKKB–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . s. Stenosis of the pulmonary or aortic orifices may result fromthe more or less complete fusion of all three cusps (Fig. 78), andthis may even proceed to complete atresia. The fusion may bethe result of foetal endocarditis or developmental error. In theformer case the valve presents much the same appearance as after686 COXliKNITAIi IMSKASKS OF TIIK HEART 687 postnatal endocarditis. Vegetations may cover the cusps, projectinto the ventricle,
RM2AXHW56–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 96. Fig. 9? 401.
RM2AXHND7–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . increasein width of the fibre, a corresponding increase in length. Thesetwo factors he considers sufficient to account for the increase with-out supposing any numerical increase in the fibres, and indeedevidence of the latter is wanting. The question can, however,hardly be considered settled as yet. The hypertrophied muscle is firm, cuts with increased resist-ance, and is usually of a deep-red colour. Increase of musculartissue without any c
RM2AXJDYB–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . cardiacdulness may be due to an associated or antecedent cardiac or pul-monary affection. Vesicular emphysema, chronic pleuritic effu-sion or hydrothorax, and cirrhosis of the right lung, may renderunavailing any attempt to determine by percussion the accuratesize of the right heart. In vesicular emphysema the borders ofthe lungs are distended, pushing the heart away from the chest-wall and occasioning such adegree of hyperresonance thatthe
RM2AXHF3A–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine .
RM2AXJ227–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fiu. 8y. THE TREATMENT OK YALYlLAK HEART-DISEASE 459 direction until the circle is completed, counter-pressure being allthe time exerted by the attendant. (8) This consists of a similar movement, executed by the leftarm. These two movements arc difficult both for the patient andthe attendant, and should not be given to patients who are veryweak or whose hearts are incapable of withstanding much exer-cise. Resistance to this movement is likew
RM2AXEWE5–Traité des maladies du coeur et des gros vaisseaux . om de polypes du cœur et desgros vaisseaux. 444 § ier. Caractères anatomiques des concrétions poly- peuses. 447 § 11. Formation des concrétions polypeuses. 429 § ni. Des effets et des signes des concrétions poly-peuses en général. 45°Section vin. De la complication réciproque des di-verses maladies du cœur. 4^4Explication des planches. 4^6 FIN DE LA TABLE. FAUTES A CORRIGER. Page 7, ligne 19, et le cœur, lisez et par le cœur. 8, 9, résultat, lisez résultats. 33, 10, observation, lisez observations. 232, 28 , de, lisez des. 260, 28, jour sava
RM2AXK70C–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . h colour. Contraction of the fibrous tissue may causeretraction or shortening of one or both of the cusps, or curling oftheir edges in a manner to prevent effective closure of the valve.In the valvular disease following acute endocarditis the shrivelledand often calcified remains of old vegetations may be found on theauricular surface of the valve along the line of maximum contact.When these old vegetations are numerous the mitral ring is us
RM2AXJXAC–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . owever, that the first sound is short andthumping, and appears to have prefixed to it a short thrill, whichcauses the impulse to convey to the hand the impression of itshaving slidden up to its maximum instead of having given a cleanthrust, as does the healthy heart. Difficult as it is to recognise thisindistinct or abortive murmur, it is extremely important to be ableto do so, since it is in the detection of obscure signs of diseasethat the
RM2AXH9TC–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 131.—From a Woman, Aged Sixty-seven, with Arteriosclerosis and fairlyWell-Compensated Mitral Incompetence. tive pulsation in the bigeminal pulse is located nearer the pre-ceding than the following full beat, and that the second abortivepulsation in the trigeminal pulse lies nearer the first abortive beatthan does the latter to the preceding full stroke. The arrhythmias thus far mentioned may be irregular in theiroccurrence, or the prolo
RM2AXET39–Traité des maladies du coeur et des gros vaisseaux . .,, W> Je- ^faiofitau ,1-ut M**j-ùu ,Ay. /Y //. %, fi. m. ^c<, -? r% ri. ir
RM2AXKBFX–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . tion of the right auricle, sec-ondary to mitral insufficiency.Cough was at no time amarked symptom, except twoor three paroxysms a fewhours before death, whenpatient seemed to have pain inleft lung. During the lastfew weeks of life there wasmoderate oedema of ankles andshins, also puffmess, but nopain, in left wrist and hand.Forty-eight to sixty hours be-fore death patient becamecomatose, with cold extremi-ties, very rapid, feeble, andirregu
RM2AXK56M–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . dependslargely upon the condition of the thoracic walls, and hence in-spection is of greatest value in persons whose hearts are dispro-portionately large as compared with the size of the chest. Palpation.—In compensated and uncomplicated mitral regur-gitation the pulse possesses no distinctive characters aside from itslowness of tension. Its rate is usually somewhat accelerated, itstension low, and in compensated cases at least, it is regula
RM2AXJP2F–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . ulse-wave were dividedinto two portions, of whichFig. 55.-P. bisferiens. the second is the stronger. Allbutts Syst. of Med., vol. v, p.931. mi , , J he former represents thesudden distention of the artery, and the latter is the palpable ex-pression of the praxlicrotic or tidal wave. Pulsus bisferiens is usu-ally stated to be found in aortic obstruction, but according toGraham Steell, cited by Clifford Allbutt, undoubtedly occurs insome cases
RM2AXK0GB–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . monic valve, is sometimes felt distinctly in thesecond left interspace, close to the sternum. Epigastric pulsationis generally pronounced, and gives the impression of a powerfullycontracting right ventricle. In compensated cases of stenosis the pulse is small, feeble, andregular, and less rapid than in mitral regurgitation. There has been much controversy, chiefly among the English,as to whether the pulse of mitral obstruction or of insuffic
RM2AXH9BP–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 136.—From a Woman, Aged Thirty-eight, with Mitral Obstruction and In-sufficiency, Lost Compensation, and Relative Incompetence of the Tricuspid.Delirium Cordis. THE SPHYGMOGRAPH 825 This form of arrhythmia is mel with, particularly, in mitralstenosis and incompetence, and in myocardial insufficiency. Itis often a late phenomenon in mitral disease;. It is of grave, butnot necessarily of fatal import, as the lost compensation may herestor
RM2AXENBJ–Traité des maladies du coeur et des gros vaisseaux . J/uvk+i. Jntt>. Util oU »x (aîafiow ? • / /y ri à $£*.
RM2AXHB78–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 124.—Hyperdicrotic Pulse from a Woman, Aged Thirty-five, after TwelveHours Eecurring Haemoptysis. Pulse, 135. quickly and widely distending them, but the flow of blood throughthe capillaries, during and immediately following the systole, andthe reflux of blood through the open valve, the instant ventricu- THE SPHYGMOGRAPB 821 lar action censes, as quickly reduce the arterial tension, and thetypical pulse of this condition is the result,
RM2AXJA9K–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . distress and ill health. Ina word, there are no symptoms peculiar to pulmonary stenosis ascontrasted with other valvular lesions. In the congenital form patients are apt to be weakly, under-sized, sometimes mentally deficient, and to manifest striking cya-nosis. This is not always present, however. In the chapter onCongenital Cardiac Affections will also be considered certainchanges in the blood that accompany marked cyanosis or the Mor-bus
RM2AXHF7A–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . Fig. 112.—Shows Dulness and Liver Out-line in Case of Aneurysm (p. 785). 790 DISEASES OF THE HEART If the sac arises from the convex aspect, it is likely to attaingreat size and exert very obvious pressure effects. If its directionof growth is forward as well as lateral, it produces a pulsatingtumour in the second and third interspaces at the right of thesternum, and not infrequently leads to erosion of the bony cover-ing. Aneurysms in this
RM2AXKB22–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . ooting up several degrees, but running so milda course as to scarcely merit the appellation of pyrexia. In others, again, the elevation of temperature is of irregulartype, or there are diurnal fluctuations, to possibly 101.5° or even102.5° F. The feature that mainly attracts attention in suchcases is the progressive anaemia, and the trifling changes discov-ered in the heart are commensurate with those of anaemia. The last of July, 1900, I wa
RM2AXKBWN–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . was wanting;throughout the prsecordiumthe sounds were obscured bymurmurs, both systolic anddiastolic, which were audibleover the entire cardiac area,but were of maximum inten-sity in the aortic area and onthe body of the sternum. Asnapping systolic tone was audible in the femoral artery. In theaortic area bimanual palpation with slight pressure brought outa systolic shock and thrill. Examination of abdomen and urinewas negative. The diagnosi
RM2AXHACP–Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . ined High-Tension Pulse from a Woman, Aged Sixty-three, withChronic Interstitial Nephritis. The following sphygmogram (Fig. 128) may be considered asfairly representing the average in chronic interstitial nephritis,and is typical of those oftenest encountered in this affection. In this connection it is fair for me to state that, highly as I value thesphygmograph, it is my opinion that its tracings in chronic interstitial nephritishave been a
