Symptoms. 1091 



and more rapidly increasing wave which disappears just as 

 rapidly, because after the termination of the systole the blood 

 can flow off rapidly toward the periphery and the heart. 

 Accordingly the pulse is strong, large, rapid and bounding 

 (Fig. 195a). A bounding pulse may be felt even in the smaller 

 arteries, and indeed in the eye ground the pulsation of the 

 arteries can usually be seen clearly. The larger, and often 

 also the smaller arteries show systolic pulsation and sometimes 

 a systolic pulsation of the liver may be observed. At the same 

 time a clapping vascular sound may often be heard even over 

 smaller arteries. Finally the mucous membranes may suddenly 

 become reddened synchronously with each ventricular systole; 

 this redness may be emphasized by producing previously a cir- 

 cumscribed pallor by the pressure of a finger tip. This capillary 

 pulsation sometimes occurs in the severe cases of aortic in- 

 sufficiency, 



(b) Stenosis of the Aortic Opening. 



In stenosis of the aortic opening the left ventricle is obliged 

 to force the normal amount of blood through an opening which 

 is smaller than normal, and this leads to the development of 

 a systolic murmur and also requires an increased expenditure 

 of energy which in its turn causes an increase in the thickness 

 of the left ventricular wall. 



The heart beat may therefore be heard over a larger terri- 

 tory and either more strongly or less strongly, because the so- 

 called closure time of the heart function is omitted. Simulta- 

 neously with the heart beat a systolic thrill may usually be felt. 

 The cardiac dullness is increased only inconsiderably. The first 

 heart sound is covered by a very strong, prolonged systolic 

 murmur, which is separated from the diastolic sound by only 

 a brief pause; this murmur may be so strong that it can be 

 heard in the neighborhood of the animal. Its maximal point 

 is in the fourth intercostal space immediately below the shoulder 

 line (Fig. 193.2). The systolic sound which originated in the 

 right heart, as well as the transmitted murmur are heard on 

 the right side also. The weakened aortic sound may be heard 

 in the left fourth intercostal space, below the shoulder line, 

 while the pulmonal sound is heard in fairly normal intensity 

 in the third intercostal space in the lower half of the left lower 

 third. The pulse wave is sluggish ; its growth may be followed 

 with the palpating finger, because owing to the aortic stenosis 

 the systolic pressure of the arteries increases much more slowly 

 than is the case under normal conditions. At the same time 

 the pulse is remarkably small and presents a distinct contrast 

 to the heart beat which is usually increased. The systolic 

 murmur is transmitted even into the smaller arteries, for in- 

 stance, those of the head and of the extremities. 



