Clinical manual for the study of medical cases / edited by James Finlayson.

Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Clinical manual for the study of medical cases / edited by James Finlayson. Source: Wellcome Collection.

    537/616 (page 509)
    ARTERIAL AND FUNCTIONAL MURMURS. 509< not carried into the arteries of the neck, or in the direction of the xiphoid cartilage. Pericardial murmur may be simulated by friction sound in the pleura on the borders of the heart. As a rule, the friction obeys the respiratory rhythm and ceases when the breath is held, but in some instances the friction, though due to roughen- ing of the pleura, is dominated by the cardiac movements. The distribution of the friction, the absence of symptoms of cardiac derangement, and perhaps the presence of other signs of pleurisy,, may guide the diagnosis. Murmurs due to Aneurisms of the Arch of the Aorta, especially of the ascending part, are with difficulty distinguished from those of aortic valvular disease. Sometimes the distinction is impossible, or can only be arrived at through the superadded signs of aneurism. (See p. 510.) Such murmurs are usually ventricular-systolic (Y.S.) in rhythm. Anaemic and Functional Murmurs (so called ELemic), as heard over the heart and great vessels, are always ventricular- systolic (V.S.) in rhythm, and they almost always simulate aortic or pulmonic murmurs as regards their area, but in rarer instances mitral. They are to be distinguished chiefly from murmurs of organic origin by the circumstances in which they occur, and by the absence of symptoms of valvular disease. A Metallic Echo of one or both Cardiac Sounds may simulate a murmur and may be produced by an air-filled cavity in the neighbourhood of the heart (tubercular cavity in the lung, pneumothorax, and the stomach). It is distinguished by its peculiar hollow, ringing, or booming quality. Reduplication of a sound is apt in some cases to simulate a murmur, especially when the reduplication is incomplete, but attention to details will minimise this difficulty. Murmurs in the Arteries. In almost all the large arterial trunks a murmur ventricular-S3rstolic (V.S.1) in rhythm may 1 Strictly speaking, and with reference to absolute accuracy indeed, the rhythm of an arterial murmur cannot be indicated in terms of cardiac deriva- tion at all; the exact time of the arterial murmur produced by the contraction