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Image from page 543 of “Diseases of the heart and thoracic aorta” (1884)

Image from page 543 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:
of the pulse.—The characterof the pulse in mitral stenosis depends upon the degree of con-striction and the condition of the muscular tissue of the heart,more especially of the left auricle. When the stenosis is great, the pulse is smaller thannormal in consequence of the fact that the left ventriclehas less blood to expel into the arterial system than underordinary circumstances. So long as the left auricle is ableto empty itself, i.e. so long as hypertrophy predominatesover dilatation, the pulse may be of good volume, goodtension, and perfectly regular, but it usually happens thatin consequence of over distention the muscular tissue of theleft auricle is every now and again stimulated to prematurecontraction, which passing to the muscular tissue of theventricle, is manifested at the wrist in the form of an im-perfect pulsation—a small pulse wave, as it were, interposedbetween two normal beats. (See fig. 206.) The small imper-fect pulse wave seems to occur during the down-stroke

Text Appearing After Image:
Fig. 206.—Pulse tracing in Mitral Stenosis. The compensation is still fairly good, a second small pulse wave is seen in thedown stroke of the third beat. of the previous beat. In the later periods of the case, andespecially when the cavity of the left auricle is constantlyover-distended and its muscular fibre in a condition of irri-table weakness, the pulse becomes quick and extremelyirregular, the irritable muscle discharging, as it were, at rapid Diagnosis of Mitral Stenosis. 493 and irregular intervals under the continuous stimulus to whichit is subjected in consequence of the increased blood pres-sure within the auricular cavity. Diagnosis.—When a case of suspected mitral stenosis comesbefore us we must endeavour to determine:— (i) Is mitral stenosis actually present? (2) If mitral stenosis is present, what is the exact extentand severity of the lesion ? Step. No. I.—Is mitral stenosis actually present f It is often impossible, as I have previously pointed out, todistingui

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