Gallop sounds in hypertension and myocardial ischaemia modified by respiration and other manoeuvres

Diastolic heart sounds and filling waves in coronary artery disease

One hundred thirty selected patieints with chest pain syndromes were studied by apex- and phonocardiography as well as by cardiac catheterization, selective cine coronary arteriography, and cine left ventriculography. Ninety-three patients had coronary artery disease; 37 did not. Abnormal graphic studies were found in 42 patients with coronary artery disease and three patients with normal coronary arteriograms. These abnormalities correlated well with the presence of elevated left ventricular end-diastolic pressure. Third heart sounds were found less frequently than fourth heart sounds and/or abnormal apexcardiographic a waves, but when present were usually associated with a depressed cardiac index. Diagnostically, over 90% of all patients with chest pain who exhibited graphic abnormalities had significant coronary atherosclerosis. Normal graphic studies did not rule out coronary artery disease, but did indicate adequate left ventricular function since only 5% of patients with normal graphic studies had elevated left ventricular end-diastolic pressure combined with a low cardiac index.

The 'A' wave of the apex cardiogram in aortic valve disease and cardiomyopathy

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Temporal alternation of atrial flutter sounds

A case of atrial flutter is reported in which the hearing of "systoles en écho" led to the recognition in the phonocardiogram of a regularly alternating time interval between successive atrial sounds during the ventricular standstill caused by stimulation of the carotid sinus. A possible explanation is proposed involving alternating pathways of atrial excitation.

Observations on the Atrial Sound in Hypertension

Recovery from heart failure in hypertensive patients having an audible atrial sound was associated with decrease in the intensity of this sound and lengthening of the P-G interval. In most patients the atrial sound disappeared entirely. The rapid intravenous infusion of saline was invariably associated with the appearance of an audible atrial sound in 10 hypertensive patients with left ventricular disease. This procedure was ineffective in producing an audible atrial sound in nine normal subjects and in eight of nine hypertensive patients without left ventricular disease. In four hypertensive patients with left ventricular disease and an audible atrial sound, the infusion of saline resulted in increase in the intensity of the sound and shortening of the P-G interval. An audible atrial sound was most frequently found in association with left ventricular disease and elevation of atrial and ventricular diastolic pressures. The findings suggest that an audible atrial sound is frequently a manifestation of cardiac dysfunction.