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In this affection, the pulsations can be seen and felt over a larger space, and the apex is more to the left and lower down than natural. The impulse is less steady, but at times more violent than that which accompanies simple hypertrophy. Percussion gives more distinct evidence of the enlargement, the sound being more extensively dull. On auscultation, the impulse is often violent, but irregular: in extreme cases, it produces the sensation of a large mass of flesh rolling or revolving beneath the ear. The pulse is strong, full, and vibratory. The shock of the heart's action is often transmitted to the whole person, and to the bed on which the patient is lying.