On the pathogenesis of the signs of traube and duroziez in aortic insufficiency. A graphic study
1943; Elsevier BV; Volume: 26; Issue: 6 Linguagem: Inglês
10.1016/s0002-8703(43)90284-4
ISSN1097-6744
Autores Tópico(s)Renal function and acid-base balance
Resumo1. A graphic study was made of the double murmur of Duroziez. Phonoarteriograms, electrosphygmograms, and other tracings were recorded on patients with aortic insufficiency and on others who had the clinical sign of a double arterial murmur upon compression. 2. The exact phase of occurrence of the second murmur has been ascertained. This is at the time of the predicrotic notch. 3. The best external pressure for the appearance of the second murmur has been studied. This is about three-fourths of the pulse pressure above the diastolic pressure, and coincides approximately with the level of the depression preceding the dicrotic wave. 4. The second murmur also occurs without compression at a certain point if compression similar to that reported above is made on a more distal section of the artery. 5. The obstacle presented either by the stethoscope bell or by a pneumatic cuff causes different changes above and below. Above the obstacle the predicrotic notch becomes deeper and the dicrotic wave becomes higher. Below the obstacle the dicrotic wave is more flattened, and may disappear. Above the obstacle the second murmur is sharp and distinct. Below the obstacle the murmur is either indistinct, or is represented by a dull snap, or is missing. The was true in patients both with and without aortic insufficiency. 6. The pulse tracing fails to reveal any abnormal deformity at the site of appearance of the second murmur. Also no deformity is found in the more peripheral pulse, in spite of the fact that the phase of appearance of the second murmur is often near the top of the main wave in the dorsalis pedis artery. 7. Simultaneous stethographic records at two points on the same artery fail to show an earlier appearance of the second murmur in the more distal section. As a matter of fact, they show a later appearance in that section, which demonstrates a peripheral blood flow during the occurrence of the second murmur. 8. Drugs which stimulate the circulation may cause the appearance of the double murmur of Duroziez in normal persons. 9. For all of the preceding reasons, a backward flow of blood during the second arterial murmur is denied, and a forward flow is admitted. The conditions of appearance are discussed, and a common explanation of the mechanism is furnished for both patients with and without aortic insufficiency. 10. The mechanism by which the sign of Traube is produced is further discussed.
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