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Image from page 134 of “Diseases of the heart and thoracic aorta” (1884)

Image from page 134 of “Diseases of the heart and thoracic aorta” (1884)
Heart Disease
Identifier: diseasesofheart00bram
Title: Diseases of the heart and thoracic aorta
Year: 1884 (1880s)
Authors: Bramwell, Byrom, Sir, 1847-1931
Subjects: Heart Diseases Aortic Diseases Heart Aorta Aorta, Thoracic
Publisher: Edinburgh, Pentland
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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Text Appearing Before Image:
Fig. 31.—Hypertrophy of the left ventricle, shelving the altered position of the apex.(After von Dusch.) The continuous line represents the normal heart; the dotted line the hyper-trophied left ventricle. The apex of the left ventricle is outside the dotted linea b, which is drawn through the left nipple. Displacement of tJie apex-beat. 115 vessel. The pulsation in this form is a little behind (after)the apex beat, but this fact is sometimes with difficultyestablished in practice. (3.) Aneiirism of the lozver part of the thoracic, or of theupper part of the abdominal aorta.-—This is not a commoncause of epigastric pulsation. The aneurismal pulsation may-be directly felt, or may be transmitted through the liver. According to Sibson, the epigastric pulsation, which iscaused by an aneurism of the lower part of the thoracic or

Text Appearing After Image:
Fig. 32.—Hypertrophy of the right ventricle. (After von Dusch.) The normal outline of the heart is represented by a continuous line : thehypertrophied right heart by a dotted line. ii6 Diseases of the Heart. the upper part of the abdominal aorta, is strong during ex-piration, but is lessened, or even disappears, during inspiration.In cases of abdominal collapse, on the contrary, the epigastricpulsation is more marked when the patient takes a deep in-spiration.^ (4.) Trite Pulsation in the liver.—Here the pulsation iscaused by a back-wash from the right auricle. The liveris always enlarged, and the pulsation is diffused through, andnot simply communicated to it. Its rhythm correspondsto the apex beat, for the blood-wave which produces it ispropelled by the right ventricle through the incompetent tri-cuspid orifice into the hepatic veins. This form of pulsationis therefore pathognomonic of tricuspid regurgitation. Insome cases of this description the hepatic pulsation maypossibly be

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