Multiple congenital cardiac lesion : a clinical lecture delivered at the university hospital / by Wm. Pepper.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Multiple congenital cardiac lesion : a clinical lecture delivered at the university hospital / by Wm. Pepper. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    REPRINTED from the University Medical Magazine, September, 1889. multiple congenital cardiac lesion. A Clinical Lecture Delivered at the University Hospital, By Wm. Pepper, M.D., Provost Professor of the Theory and Practice of Medicine, University of Pen nsylvania. [Reported by I)r. A. L. Benedict.] G. AGEd 5. Even when a baby, he seemed to have an abnormal amount of palpitation about the heart. He has had none of the diseases of childhood. East winter he had a little fever, and was found to have heart disease. His cheeks are a little flushed but his fingers are not clammy. There is marked pulsation of the vessels of the neck and the supra-sternal notch. His chest is symmetrical and so are the respiratory movements. The prsecordia is a little prominent, and there is a visible heaving pulsation over it. The apex- beat of the heart is in the fifth interspace ; it is very forcible in the nipple line and extends beyond it. There is an evident thrill occupying nearly the whole of the diastolic period of the pulsation, especially marked in the second inter- space from the sternum outward. The cardiac dulness begins just below the left sterno-clavicular articulation and extends in a curved line to the beginning of the right second interspace, and thence downward three-quarters of an inch to the right of the sternum till it is lost in the liver dulness. From the left sterno-clavicular junction the dulness extends a little beyond the nipple line and thence to the apex. The cardiac dulness extends too high and too widely ; it goes to the right of the sternum and is felt outside the nipple. There is a transverse diameter of U/2 inches and a vertical diameter of 4 inches. Such a cardiac dulness we would suppose would be produced by a general hypertrophy involving the ventricles and auricles of both sides of the heart. We would say then, without going any further in the examination, that this heart which gives us in a child five years old such an area of dulness should be the seat of a general hypertrophy. Auscultation reveals a distinct systolic murmur at the apex. A second sound is heard, but it is accompanied by a slight diastolic murmur. The sys- tolic murmur is transmitted into the arm-pit, and the diastolic murmur is also faintly heard there. At the xiphoid cartilage both murmurs are audible. At the aortic cartilage there is a short systolic murmur ; this is followed by the diastolic murmur which is more clearly heard at this spot. Both murmurs are heard very distinctly over the sternum. At the pulmonary cartilage both sys- tolic and diastolic murmurs are excessively loud. In fact the diastolic murmur there is louder than the systolic.