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Saint Bartholomew's Hospital Reports, 1877, Vol. 13 (Classic Reprint)

Saint Bartholomew's Hospital Reports, 1877, Vol. 13 (Classic Reprint)

139198635
1975 руб.
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Описание
Excerpt from Saint Bartholomew's Hospital Reports, 1877, Vol. 13

For whatever may be the true theory of the production of murmurs, whether by ?uid veins or otherwise, no one, I imagine, believes that a murmur can be produced at either auriculo - ventricular orifice when the blood in it is at rest. The existence of an endocardial murmur necessitates the simultaneous existence of some blood-movement at the spot where it is produced. But if the blood is in movement, it must be passing either into or out of the ventricle; if the former be the case, the ventricle must be dilating; if the latter, it must be contracting; for the blood never passes in a continuous stream through the ventricles, as it does through the auricles. All mitral and tricuspid murmurs must therefore be, in the proper sense of the words, either systolic or diastolic. It makes no difference whether they occupy the whole, or a part only, of the systolic or diastolic periods their nature does, and their name ought to, depend upon the state of the ventricles at the time of their production, and Upon this alone. The words Systole and Diastole have primarily nothing whatever to do with the sounds of the heart which occupy a part only, and a constantly varying part, of these periods, and the attachment of such reference to them by some writers is, I know, a frequent source of great confusion in the minds of students.

All murmurs, then, produced at the mitral orifice during the ?ow through it of blood into the ventricle are diastolic, although in practice, and for purposes of accurate diagnosis, it is con venient to distribute them further into three main classes. According to the portion, more or less, of the diastolic period which they may chance to occupy. Thus, a diastolic murmur at the apex may take place at the beginning or at the end, or it may be prolonged throughout the whole, of the diastolic period, but in each case it remains equally and always diastolic. To the murmur which occurs at the end of the diastole, and often seems to be continuous with the first sound of the heart, the name Praesystolic has been given, and it would no doubt be highly inconvenient to relinquish a name, sanctioned by long usage, for a murmur which is generally of peculiar character and significance: only be it always remembered that praesystolic are nothing more than one of the varieties of diastolic murmurs.

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