File:A treatise on the principles and practice of medicine (1916) (14595840938).jpg

Identifier: treatiseonpri00edwa (find matches)
Title: A treatise on the principles and practice of medicine
Year: 1916 (1910s)
Authors: Edwards, Arthur Robin, 1867-
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Publisher: Philadelphia : Lea & Febiger
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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of the aorta; or leakage continuing into the beginning of thesystole, (c) Weakness or absence of the second aortic tone is explained byimperfect closure of the valves. As the second tone is normally heardover the carotid artery, it should be listened for there, because it isremoved from the murmur and the second pulmonic tone. If it is pres-ent, one or more valves are closing, though probably imperfectly. By lift-ing the stethoscope a little from the skin over the aortic region, the secondsound, previously obscured by the bruit, may be heard, (d) The firstmitral tone is often weak or lost, because the papillary muscles are flattenedand indurated by the regurgitant column, or a mitral systolic murmurmay replace the first tone, (e) An apical presystolic (Flints) murmur isdue to aortic leakage continued in the systole, or to pressure on themitral valves, which hinders the flow of blood from the left auricle intothe left ventricle (Flint, 1862). Thayer found it in GO per cent, of 74 O n~
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ENDOCARDITIS 355 cases, and in less than one-quarter of these was there coincident mitralstenosis. (/) Arterial tones and murmurs result from vibration of thevessel wall; the tones may become murmurs, when there is great differ-ence in tension. The systolic vessel tone is increased by the largervolume of blood and increased ventricular action, and is most plainwhen the vessels are not sclerotic. The femoral systolic tone is convertibleinto a murmur on pressure. Traubes double femoral sounds consist of twospontaneous tones (produced without pressure), most satisfactorilyexplained by sudden change in tension. They are heard best when theheart is strong and the vessels soft. They may be confused with thedouble venous (Friedreichs) tones, heard over the vein in tricuspidleakage. Duroziezs double murmur consists of two murmurs, elicited byslight pressure and due to the progress and recession of blood in theartery. These phenomena also occur in other conditions. Diagnosis.—Physical examin

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