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At least 685 records · Page 38Linked to original sources
PubMed1975

First heart sound and ejection sounds. Echocardiographic and phonocardiographic correlation with valvular events.

To provide additional information on the relation of valvular events to the principal components of the first heart sound (s1), combined echocardiograms and phonocardiograms were recorded in 49 subjects, chosen because of audible splitting of S1 or a combination of S1 and an ejection sound. The subjects included 14 normal persons, 16 patients with a variety of predominantly right-sided heart conditions, 7 with mitral stenosis, 3 with pulmonary stenosis and 9 with aortic valve disease or systemic hypertension. A precise relation was found between completion of closure of the atrioventricular (A-V) valves manifested in the echocardiogram and the high-frequency components of S1 (M1 and T1). The average time from the Q wave of the electrocardiogram to M1 was 0.06 plus or minus 0.003 second and the Q-T1 interval was 0.09 plus or minus 0.002 second. In mitral stenosis the Q-M1 interval was delayed to 0.10 plus or minus 0.005 second, resulting in some instances in reversed splitting of S1. In pulmonary stenosis, the ejection sound occurred 0.10 plus or minus 0.003 second from the Q wave. In 7 of the 16 patients with various right-sided abnormalities, but without valvular stenosis, an ejection sound of pulmonary origin occurred 0.18 plus or minus 0.012 second from the Q wave. In the nine patients with aortic valve disease or systemic hypertension, the time from the Q wave to the aortic ejection sound was 0.13 plus or minus 0.004 second. With only two exceptions the ejection sounds of aortic and plumonary origin coincided exactly with achievement of a fully opened position of the respective semilunar valve. Our findings support the postulate that M1, T1 and the ejection sounds occur in association with closing or opening of valves with consequent sudden deceleration or acceleration of a column of blood that, in turn, results in vibrations of the cardiohemic system and audible sounds.

Adolescent↗
PubMed1975

Pericardial rub. Prospective, Multiple observer investigation of pericardial friction in 100 patients.

A prospective, multiple observer ausculatory and phonocardiographic study of 100 patients with pericardial friction confirmed the dominant prevalence of triphasic pericardial rubs (56 percent of patients with sinus rhythm). In 9 of 33 patients with various biphasic rub patterns there was summation of the ventricular diastolic rub with the atrial systolic rub, concealing an additional 10 percent of potential triphasic friction. Fourteen of 15 monophasic rubs were audible or recordable only during ventricular systole. Rubs were best heard along the left sternal border in 84 percent of cases and tended to be louder during inspiration than during expiration; in 35 cases there was no respiratory predilection. Twenty-three rubs were palpable. Ten rubs occurred in patients with pericardial effusion, five of whom had tamponade. Extension of the neck did not have a dependable effect on rub intensity.

Cardiac Tamponade↗
PubMed1975

Prolapse of the posterior leaflet of the mitral valve associated with secundum atrial septal defect.

The association of prolapse of the posterior leaflet of the mitral valve with secundum atrial septal defect has recently been reported but the prevalence and features of this association have not been defined. Analysis of left ventricular cineangiograms in 54 patients have secundum atrial septal defect revealed evidence of prolapse of the posterior leaflet of the mitral valve in 20 (37 percent). In 11 patients (20 percent) there was clinical evidence of a mitral valve lesion (pansystolic murmur in 9 patients and mid-systolic click in 2 patients, 1 of whom also had a late systolic murmur); the remaining 9 patients had no auscultatory evidence of a mitral valve lesion. Thus, the incidence of clinically silent prolapse in association with secundum atrial septal defect was 17 percent (9 of 54 patients). Analysis of the angiographic findings revealed that the prolapse was triscalloped in 4 patients, biscalloped in 11 and uniscalloped in 5. Mitral regurgitation was present in 12, including the 11 patients with clinical signs of a mitral lesion. Three patients with moderate or severe mitral regurgitation had triscalloped prolapse. The association of prolapse of the posterior leaflet of the mitral valve with secundum atrial septal defect is common and may be present in the absence of any clinical evidence of a mitral valve lesion.

Adult↗
PubMed1975

Late systolic murmur of rheumatic mitral insufficiency.

Of 184 patients with acute rheumatic fever and associated mitral insufficiency encountered during a 15 year period, 34 manifested a mid-late systolic murmur or a nonejection click, or both, during the course of follow-up. The mid-late systolic murmur later disappeared in four patients whose condition is now considered normal. In one of the four, systolic prolapse of the mitral valve was demonstrated on an angiocardiogram obtained when the systolic murmur was present. Since disappearance of the murmur there has been no evidence of systolic prolapse on meticulous echocardiographic study of the mitral valve. In another child with angiographically demonstrated systolic prolapse of the mitral valve the systolic murmur has also disappeared, but systolic prolapse is still evident on echocardiographic study. None of the 34 patients with a mid-late systolic murmur manifested the T wave abnormalities commonly associated with the familial variety of mitral valve prolapse.

Acute Disease↗
PubMed1975

Loud first heart sound with long P-R intervals.

A case of partial atrioventricular block with Wenckebach periods and a loud first heart sound (S1) associated with the longest P-R interval of the cardiac cycles is described. Although the surface electrocardiogram provided no clues to this paradoxical behavior, the intraatrial electrogram revealed that the long P-R interval with the loud S1 was accompanied by atrial echoes (reciprocal atrial beats). The loud S1 with a very long P-R interval was always caused by an atrial contraction synchronous with the QRS complex.

Adolescent↗
PubMed1975

Handy heart sound simulator.

A simple bedside technique of heart sound simulation using hand and stethoscope is described. The technique utilizes tissue vibration and sound conduction with the usual air column of a stethoscope to reproduce auscultatory events accurately without the distortion that often accompanies electrical production of heart sounds.

Aortic Valve Stenosis↗
PubMed1975

Diagnosis and management of complications of prosthetic heart valves.

Complications after heart valve replacement remain a substantial source of morbidity and mortality despite continuing advances in surgical care and prosthetic design. Infectious endocarditis occurs in about 4 percent of patients and may appear early (within 60 days) or late after operation. Endocarditis of early onset is commonly due to staphylococcal, fungal or gram-negative organisms and is fatal in 70 percent or more of cases. Infection of late onset is more often of streptococcal origin and the mortality rate is lower, about 35 percent. With either type, prompt recognition, vigorous and appropriate antimicrobial therapy and early consideration of surgical intervention are crucial. The postperfusion and postpericardiotomy syndromes are relatively common and relatively benign syndromes associated with postoperative fever. Their recognition is important to prevent confusion with endocarditis or sepsis and thus to reassure the patient and physician. Treatment is primarily symptomatic. Intravascular hemolysis occurs with most prosthetic heart valves but is more common with certain prostheses and with paraprosthetic valve regurgitation, with significant hemolytic anemia in 5 to 15 percent. Oral iron replacement therapy is effective in the majority of patients, but occasionally blood transfusion or reoperation for leak around the prosthesis is necessary. Prosthesis dysfunction due to thrombus may be recognized clinically by recurrence of heart failure, syncope, cardiomegaly and altered prosthetic valve sounds or new murmurs. Hemodynamic studies verify the diagnosis, and prompt reoperation is indicated for this potentially lethal problem. Systemic embolization has decreased markedly with the introduction of cloth-covered prostheses and is frequently related to erratic or ineffective anticoagulant therapy. We continue to recommend anticoagulant therapy for all patients with prosthetic heart valves unless there is a major contraindication.

Anemia, Hemolytic↗
PubMed1975

Precordial honk due to tricuspid regurgitation.

A systolic honk developed in a woman with idiopathic cardiomyopathy and congestive heart failure. The honk was present only during deep inspiration, disappeared as her cardiovascular status improved, but recurred when her cardiovascular function declined. Further investigation indicated that the honk was the result of tricuspid regurgitation.

Cardiac Catheterization↗
PubMed1975

Radiographic appearance of the thorax in systolic click-late systolic murmur syndrome.

The posteroanterior and lateral chest X-ray films of 64 consecutive patients with an isolated systolic click (55 patients) or a systolic click with a late systolic murmur (9 patients) showed a striking frequency of thoracic skeletal abnormalities. There were 50 female and 14 male subjects. The average age of the female subjects was 36.7 years (range 13 to 67), that of the male subjects 39.7 years (range 17 to 56). Seventy-two percent of the female and 78 percent of the male subjects had an anteroposterior/transverse thoracic ratio less than the mean ratio in a small population. Bony abnormalities such as pectus excavatum, straight thoracic spine and scoliosis occurred alone or in a combination in 31 of the 50 female patients (62 percent) and in 8 of the 14 male patients (57 percent). Overall, 39 of the 64 patients (61 percent) had at least one of the skeletal abnormalities. Scoliosis occurred in 25 subjects (39 percent) and was mild in 19. A "straight back" was found in 15 (23 percent) and pectus excavatum in 7 patients (11 percent). The explanation for these findings is not apparent. Thoracic cage abnormalities should be included as one of the nonauscultatory features of the systolic click-late systolic murmur syndrome.

Adolescent↗