Identifier: diseasesofchestp1920norr (find matches)
Title: Diseases of the chest and the principles of physical diagnosis
Year: 1920 (1920s)
Authors: Norris, George William, 1875-1965 Landis, Henry R. M. (Henry Robert Murray), 1872-1937, joint author Krumbhaar, E. B. (Edward Bell), 1882-1966
Subjects: Chest Diagnosis Thoracic Diseases Diagnosis
Publisher: Philadelphia, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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ing ventricular systole the heart (1) becomes smaller, especiallyin its transverse diameter; (2) twists about its longitudinal axis from leftto right and forward (Hirschfelder). It has been graphically shown that what we see as the apex beatconsists of variable and often complex elevations and depressions of theprecordium. The movements may be grouped as: 1. A normal type: a considerable protrusion of the precordium, occur-ring with and during ventricular systole. Graphic tracings in such acase show three waves: (a) auricular systole; (6) ventricular systole; (c)rebound due to ventricular diastole (see Fig. 129). 2. Elevation of the whole precordium due to pivotal action of the 199 200 THE EXAMINATION OF CIRCULATORY SYSTEM heart against the vertebral column. Seen chiefly in hypertrophiedhearts, especially in flat-chested people. 3. Systolic retraction. During systole, the right side of the right ventricle tends to recedefrom the chest wall. When this chamber is hypertrophied or acting
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Right •auricular appendage Diaphragm Fig. 1G3.—The cardiac impulse (apex beat) does not correspond to the anatomicapex of the heart but is due to a sudden hardening and increase in tension of the anteriorsurface of the right ventricle, about 1 inch (2.5 cm.) to the right of the anatomic apex. Practically the whole anterior surface of the heart, is the right heart. The left ventriclenormally forms only the extreme left border of the anterior surface and comes in contactwith the chest wall mainly when this chamber is enlarged, as is the case in the accompany-ing photograph, in which the whole heart, but especially the left ventricle, is greatly hyper-trophied. forcibly, sufficient negative intrathoracic pressure is produced to causea sinking in of more or less of the precordium. This normal retractionis sometimes mistakenh^ attributed to pericardial adhesions. When bothelevation and retraction are coincidentallj present over different areas,we get an impression of a wavj or peristal

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