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Examination of the Heart

disease, history, impulse and palpitation

EXAMINATION OF THE HEART - when considering the history and general symptoms of diseases of the chest, it was remarked that dyspncea and palpitation are the chief subjects of complaint with patients suffering from disturbance of the circulation, and that the history of the attack is usually obscure and imperfect. It may be added that these symptoms are much more frequently mentioned when their cause is merely functional than when organic lesion exists. Pain is an almost constant attendant on pericardial inflammation; it is also occasionally met with in old structural changes, present ing itself sometimes under the form of angina. A. history of rheumatic fever, any indications of a tendency to dropsy, or the presence of chronic lung affection, and especially of bronchorrhosa, are each of them more or less valuable in estimating the proba bility of disease of the heart. In most instances, however, its presence may be very conclusively shown by the action of the pulse, the discoloration of the face, the impulse against the ribs which accompanies the movement of the organ, and the characters of the sounds produced, as they are changed by specific forms of disease. Errors in diagnosis chiefly arise from confounding the signs of the functional with those of the structural maladies.

We must presume that the student is familiar with the position and average force of the impulse which each stroke of the heart conveys to the finger placed between the fifth and sixth rib; with the usual extent of dulness on percussion observed in the pro cordial region, when it is of normal size; and with the sounds which accompany its systole and diastole in a state of health, hence called systolic and diastolic, or first and second sounds. In

each of these particulars, changes may be perceived which are quite independent of disease of the heart; its position may be altered by effusion into the pleura or peritoneum; its impulse may be rendered more evident by emaciation, or by consolidation of the lung, or may be lessened by opposite states; the sharpness and force of the shock may be greatly increased by mere nerv ous excitement; and the prEecordial dulness may be diminished or increased in extent, as it happens to be more or less govered by resonant pulmonary tissue.

Nervous palpitation without increase of size of the heart itself, will be observed to vary much in intensity from time to time, and this especially aecording to the mental condition, whether of excitement or of depression. Attention directed to the organ greatly influences it, and not unfrequently the fact of making the examination is of itself sufficient to excite or increase the palpi tation, which again gradually subsides; this condition is one which attracts the patient's notice much. more than palpitation depending on real disease.