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Right ventricular myxoma. Case report and review of phonocardiographic and auscultatory manifestations.

Tumors in the right ventricle are extremely rare. This report concerns the pathogenesis of physical signs resulting from a right ventricular myxoma. In systole a loud midsystolic murmur representing outflow obstruction was present. In diastole a prominent vibration was heard and recorded. By echophonocardiography this noise could be ascribed to sudden halting of the retrograde excursion of the mass into the right ventricle--a mechanism analogus to the tumor "plop" associated with the halting of antegrade movement of a left atrial myxoma in the left ventricle in early diastole.

Adolescent↗

Mitral valve prolapse in anxiety neurosis (panic disorder).

Our purpose was to determine the incidence of mitral valve prolapse in patients with anxiety neurosis or panic disorder, with symptoms including recurrent anxiety attacks, dyspnea, palpitations, chest pain, dizziness, and paresthesias. Twenty-one patients and 20 age- and sex-matched normal controls were studied. Objective cardiac abnormalities were significantly (p < 0.05) more frequent in the patient group as compared to the control group; these comprised echocardiographic prolapse, ST-T abnormalities on resting ECG, premature ventricular contractions on exercise ECG, and the combination of echo prolapse with clicks/murmurs of exercise-induced PVC. We conclude that patients with anxiety neurosis or panic disorder may also have evidence of an organic abnormality--the mitral prolapse syndrome.

Adult↗

Newly developed systolic murmur in patients with a transvenous pacemaker.

We encountered four cases in which a transvenous cardiac pacemaker produced a systolic musical murmur in the absence of any complications. This systolic murmur appeared only when the pacing was being cut off and disappeared soon after the pacing had been turned on. Although the exact mechanism of production of the murmur remains uncertain, several possible mechanisms for its occurrence are discussed. It is apparent from this study that a systolic murmur can newly occur without any obvious cause in patients with a transvenous pacemaker.

Aged↗

Frequency analysis approach to the origin of the first and second heart sounds.

Catheter-tipped micromanometers were used to simultaneously record left ventricular and aortic pressures, and left ventricular and aortic internal phonocardiograms in order to determine if they had a common mode of origin and propagation. Spectrographic analysis showed that even with high-pass filtration the phonocardiogram obtained with a commonly used system (Millar) contained large amounts of energy in the subaudible frequency range (below 40 Hz). It was possible to derive close facsimiles of the phonocardiograms by double differentiation of the corresponding pressure pulse and conversely to derive the pressure pulse by double integration of the phonocardiograms. The propagation velocities of the first heart sound, second heart sound, and the foot of the aortic pressure pulse were found to be similar and were respectively, 4.3 +/- 0.2, 4.6 +/- 0.3, and 4.2 +/- 0.2 m/sec (+/- SE). These data support the concept that the low frequency pressure variations produced by the heart, which predominate in the left ventricular and aortic pressure pulse waveforms, are generated and propagated in the same manner as the high frequency pressure variations, which are the first and second heart sounds.

Animals↗

Nuclear techniques in ischemic heart disease.

Until recently, it was necessary to measure parameters such as ventricular pressure to assess the effects of drugs on the force of myocardial contraction--the inotropic effect. Even simpler measurements such as cardiac output are not completely satisfactory, because they are determined not only by the contractile state but also by the diastolic volume of the ventricles, outflow impedance, and heart rate. Within the past few years, the use of radioactive tracer techniques has made it possible to measure the changes in ventricular volume that occur throughout the cardiac cycle. With these techniques, it is now possible to measure end-diastolic and end-systolic volumes, the rates of ventricular emptying and filling, stroke volume, and systolic and diastolic time intervals. In complicated diseases such as combined valvular and coronary artery disease the ventricular response to antiarrhythmic, vasodilator, and inotropic drugs can be assessed in individual patients.

Cardiac Output↗

Echo-phonocardiographic features of regurgitant porcine mitral and tricuspid valves presenting with musical murmurs.

Echophonographic findings of three patients with spontaneous degeneration of porcine tricuspid and mitral valves presenting with musical murmurs are reported. Echocardiography in all these patients revealed systolic or diastolic cusp flutter similar in frequency to the musical murmur on simultaneously recorded phonocardiogram. Porcine tricuspid regurgitation is usually well tolerated and can be followed clinically for many years. However, patients with mitral porcine valves usually become symptomatic or present with congestive heart failure and usually require valve surgery soon after clinical or echo-phonocardiographic findings of valve regurgitation appear.

Aged↗

The prevalence of ruptured chordae tendineae in the mitral valve prolapse syndrome.

Echocardiographic studies were performed on 134 consecutive patients with idiopathic mitral valve prolapse syndrome. Fifteen patients (11.2%) were noted to have ruptured chordae tendineae on M-mode examination and in 12 of them the diagnosis was confirmed by bidimensional studies. Only four patients were referred for surgery as a result of severe mitral regurgitation. At operation one patient was found to have rupture of the anterior mitral chorda and the other three had posterior mitral chordal rupture. Eleven patients with chordal rupture had either mild symptoms or were completely asymptomatic. It is concluded that chordal rupture in patients with the mitral valve prolapse syndrome does not always result in severe hemodynamic deterioration and may go undetected unless a high index of suspicion is maintained. Serial echocardiographic studies may reveal the natural history of this condition in asymptomatic patients.

Adolescent↗