Diastolic movements of the precordium in mitral stenosis and regurgitation

Relation between apexcardiographic a wave and posterior aortic wall motion

Left ventricular end-diastolic pressure, an apexcardiogram and an aortic root echocardiogram were recorded in 24 patients. Eleven patients (46%) had a ratio of atrial to total amplitude (a/OE ratio) greater than 14% in the apexcardiogram, and all patients had a left atrial systolic posterior aortic wall motion after the conduit period that was greater than 50% of the total posterior aortic wall excursion as measured from the O to V points (A/OV ratio) on the echocardiogram. Only 2 of 24 patients (8%) had an echographic A/OV ratio greater than 0.5 with an apexcardiographic a/OE ratio of less than 14%. There was a significantly (P less than 0.001) high degree of positive correlation between the apexcardiographic a/OE ratio and the echographic A/OV ratio (r = 0.81), the a/OE ratio and left ventricular end-diastolic pressure (r = 0.82), and the A/OV ratio and left ventricular end-diastolic pressure (r = 0.75). It is concluded that the amplitude of posterior aortic root motion during atrial systole in relation to total posterior aortic wall motion may provide a useful index for the noninvasive assessment of left ventricular compliance and end-diastolic pressure.

On the clinical value of calibrated displacement apexcardiography

A new type of displacement transducer for recording the calibrated left apexcardiogram (QLAC) has been evaluated in 69 normal subjects and 99 cardiac patients. Total displacement of QLAC (TD), its peak first derviative (peak dD/dt (t-peak dD/dt). A strong corretation exists between peak dD/dt and TD in normal subjects (r=0.95) and the deviation from the normal relationship allows a separation between normal and abnormal ventricular function. In normal subjects (dD/dt/Dt) max averaged 34.2 plus or minus 5.7 sec-1; it was signigicantly lower in patients with congestive cardiomyopathy (26.5 plus or minus 6.3 sec-1 p greater than 0.005). This index correlates with left ventricular end-diastolic pressure (LVEDP) (R = - 0.69) and with ejection fraction (R - 0.66) and behaves as expected during positive and NEGATIVE INOTROPIC interventions. The index (dD/dt/Dt) max is superior to TD and peak dD/dt, being less variable independent of thorax circumference and better correlated with hemodynamic parameters. The index t-peak dD/dt was 53.9 plus or minus 9.5 msec in normal subjects and 81.6 plus or minus 18.9 msec in patients with congestive cardiomyopathy (p greater than 0.001). This time-interval correlates weakly with LVEDP (R = 0.04) and with ejection fraction (R = - 0.66). It is concluded that the normalized first derivative of QLAC provides useful information on left ventricular function.

Apex cardiogram and systolic time intervals in acute myocardial infarction

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Praecordial tracings of myocardial aneurysms

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Reflected ultrasound as a diagnostic instrument in study of mitral valve disease

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Quantitation of precordial movement. I. Normal subjects

A method has been devised for calibrating and measuring aspects of displacement records of cardiac movement. Forty-five normal subjects have been studied using this method, and a normal range has been calculated for the heights of the a wave, systolic outward movement, rapid-filling wave, and the ratio of rapid-filling wave to duration. The consistency of the results obtained and factors producing variations are discussed.

Quantitation of precordial movement. II. Mitral regurgitation

Precordial displacement records of 39 patients with mitral regurgitation have been analyzed using a new method of quantitation. Three groups of patients were studied, and the data from each group have been compared in a number of different ways to those obtained from a control group. The optimal method of discrimination is a graphic representation involving the two variables of the height of the outward movement in systole and the height of the rapid-filling wave. This method allows discrimination between normal persons and patients with mitral regurgitation in a high proportion of cases.

It is postulated that the increase of systolic outward movement in patients with mitral regurgitation is related to an increase in stroke volume of the left ventricle, and the increase in the height or the slope of the rapid-filling wave represents increase in flow and rate of flow into the ventricle in early diastole. The importance of consideration of the functional status of the ventricle in the assessment of precordial movement is stressed.

The Normal Apex Cardiogram

The configuration of the apex cardiogram and its temporal relationship to the electrocardiogram, phonocardiogram, carotid pulse, and jugular venous pulse were analyzed in 25 normal subjects. In two patients with rheumatic valvular disease simultaneous electrocardiograms, phonocardiograms, left intraventricular pressure and apex cardiograms were obtained. In all cases the apex cardiogram showed a characteristic and reproducible contour in both its systolic and diastolic components. The curves of the apex cardiogram display all consecutive phases of the cardiac cyle; contraction-and-emptying and relaxation-and-filling. It bears a constant relationship to the phonocardiogram and is more useful as a reference tracing for acoustic events than the electrocardiogram, carotid pulse, or jugular venous pulse. The onset of the systolic wave of the apex cardiogram precedes the rise of left intraventricular pressure and mitral valve closure. The maximal systolic peak of the apex cardiogram occurs simultaneously with the onset of left ventricular ejection and the rise of the carotid pulse pressure. Small deflections are frequently inscribed on the apex cardiogram at the time of mitral, tricuspid, and aortic valve closure.

The wave form of the apex cardiogram is caused primarily by movements of the left ventricle against the chest wall. It is thus a translation of the sequence of hemodynamic events occurring in the underlying left ventricle. The inaccuracy of the jugular venous pulse for timing right- and left-sided cardiac events is emphasized.

Precordial Vibrations Clinical Clues from Palpation

The low-frequency precordial vibrations originating at the point of the apex beat, and especially those in the subaudible range, seem to offer considerable clinical usefulness. In this paper I have briefly outlined some of the physiologic, pathologic, and pharmacologic evidence to support this impression. The instrumentation we have used is crude and undoubtedly we have been misled on occasion by artifacts. However, there is sufficient validity in the technic, reproducibility of result, and correlation with intracardiac events to warrant intensive study.