Excerpt from The Montreal Medical Journal, 1899, Vol. 28
The apical murmurs of pernicious anaemia, however, do not always present the other cardiac conditions that we would expect to find in a relative mitral incompetency of some duration. The murmur is generally transmitted, but in only ten cases is there cardiac enlarge mentor pulmonary accentuation; but the absence of these signs is explained by the physical facts. We cannot expect much increase in area where the heart though frequently dilated, is atrophied rather than hypertrophied, and the right ventricle must often be too weak to give rise to pulmonary accentuation. In pernicious anaemia where pulmonary accentuation does occur (as in most advanced cases) it is probably dependent on the dyspnoea, due. To the imperfect aeration of the tissues by the diminished number and power of the oxygen-carry ing elements of the blood.
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