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eFigure 10–8. The timing of the principal cardiac murmurs. Heart murmurs can be either systolic or diastolic. During systole, while the LV is contracting, the aortic valve is open and the mitral valve is closed. Turbulent flow can occur either because of an incompetent mitral valve, leading to regurgitation of blood back into the atrium, or from a narrowed aortic valve. In diastole, the situation is reversed, with filling of the LV through an open mitral valve while the aortic valve is closed. Turbulent flow occurs when there is narrowing of the mitral valve or incompetence of the aortic valve. Stenosis of valves usually develops slowly over time; lesions that cause valvular regurgitation can be either chronic or acute. (Reproduced, with permission, from Hammer GD, McPhee SJ. Pathophysiology of Disease, 8th ed. McGraw-Hill, 2019.) Several examples depict the timing patterns of different cardiac murmurs.

Current Medical Diagnosis & Treatment 2025 > Signs of Heart Disease

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eFigure 10–26. Aortic stenosis. A: Drawing of the left heart in left anterior oblique view showing anatomic features of aortic stenosis. Note structures enlarged: LV (thickened); poststenotic dilation of the aorta. (Reproduced, with permission, from Hammer GD, McPhee SJ. Pathophysiology of Disease, 8th ed. McGraw-Hill, 2019.) B: Drawing showing auscultatory and hemodynamic features of predominant aortic stenosis. Cardinal features include LVH and systolic ejection murmur. (EC, ejection click; SM, systolic murmur; P, pulmonary valve; A, aortic valve.) (Reproduced with permission from Cheitlin MD et al, eds. Clinical Cardiology, 6th ed. Appleton & Lange: The McGraw-Hill Companies Inc, 1993.) C: Pressure–volume loop in aortic stenosis. The LV becomes thickened and less compliant, forcing the diastolic pressure-volume curve upward, which results in elevated LVEDP (a′). Because the LV must pump against a fixed gradient (increased afterload), b increases to b′. Finally, the hypertrophy of the ventricle results in increased inotropic force, which shifts the isovolumic pressure curve leftward. A three-part illustration depicts the hemodynamic changes in aortic stenosis. A chest x ray reveals an enlargement of the heart in the lower quadrant, resulting from aortic stenosis.

Current Medical Diagnosis & Treatment 2025 > Aortic Stenosis

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eFigure 11–2. In diastolic dysfunction, the diastolic pressure-volume relationship is shifted upward and to the left (dashed line), which leads to an elevated LV end-diastolic pressure a and reduced stroke volume. (Reproduced, with permission, from Hammer GD, McPhee SJ. Pathophysiology of Disease: An Introduction to Clinical Medicine, 8th ed. McGraw-Hill, 2019.) A graph shows the relation between pressure and volume during diastolic dysfunction.

Current Medical Diagnosis & Treatment 2025 > Heart Failure

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eFigure 28–19. Typical findings in Cushing syndrome. (Reproduced with permission from Hammer GD, McPhee SJ. Pathophysiology of Disease: An Introduction to Clinical Medicine, 8th ed. McGraw-Hill, 2019.) An illustration shows the typical findings in Cushings syndrome.

Current Medical Diagnosis & Treatment 2025 > Primary Adrenal Insufficiency (Addison Disease)

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eFigure 31–1. Role of obesity in the pathophysiology of weight-related diseases. Short arrows refer to a change in the indicated parameter, and long arrows indicate a consequence of that change. In some cases, evidence is epidemiologic; in others, it is experimental. (Modified from Bray GA. Pathophysiology of obesity. Am J Clin Nutr. 1992;55:488S.) An illustration shows the role of visceral fat storage in the pathophysiology of disease.

Current Medical Diagnosis & Treatment 2025 > Obesity

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Figure e4–8. Single heel raise examination with the heel raised off the weight-bearing surface. The patient may or may not be able to perform the single heel raise or will be in pain while performing the single heel raise. Also shown is the posterior tibial dysfunction with the heel not being in rectus or an inverted state. (Used, with permission, from C. Parks, DPM.) The patient lifts the heel with support of the toes on the left foot. The calcaneus is moved slightly to the lateral side, at the ankle joint.

Current Medical Diagnosis & Treatment 2025 > Flatfoot (Pes Planus)

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