| FIG. 42. |
| Aortic Regurgitation. |
| FIG. 43. |
| Aortic Obstruction and Regurgitation (from a Patient in Bellevue Hospital). |
This vibrating pulse or pulse of unfilled arteries is usually possessed of fulness of volume, but when obstruction coexists it may be small and flickering unless the arteries are calcified or atheromatous. The pulse of aortic insufficiency taken by the sphygmograph resembles strongly the pouls des vieillards, but the senile pulse gives a rounded instead of a pointed summit. Still, in old age the two tracings may be indistinguishable.10 The peculiar crochet or beak is noticeable in graphic tracings of the pulse of aortic inadequacy.
10 Marey, Phys. Méd. de Circ. du Sang, Paris, 1863.
Stokes has described, under the designation of steel-hammer pulse, a peculiar and characteristic pulsation of the arteries which occurs in cases of acute rheumatic arthritis supervening upon chronic inadequacy of the aortic valves. The pulse is abrupt and energetic, as the rebound of a smith's hammer from the anvil; it is exhibited, however, only in the arteries adjacent to the affected joints.11
11 Continued Fever, 1874, p. 244.
PHYSICAL SIGNS.—Inspection.—There is an increase in the area of the apex-beat, which is plainly more forcible and is visible over a wider area than in aortic obstruction. After compensation has ceased to balance the forces in the heart the apex-beat becomes more and more feeble and diffused. One of the most important points obtained by inspection is pulsation of the carotids and the vessels of the upper extremities. Becker and Quincke have observed pulsation of the retinal vessels in cases of extensive aortic regurgitation.12
12 London Ophth. Hosp. Rep., Feb., 1873.