Document Detail

The genesis of the third and fourth heart sounds. A pressure-flow study in dogs.
MedLine Citation:
PMID:  6715543     Owner:  NLM     Status:  MEDLINE    
To examine the mechanism of mitral flow deceleration in diastole and its potential influence on the genesis of third (S3) and fourth (S4) heart sounds, we simultaneously recorded left atrial and left ventricular pressures (micromanometers), mitral flow velocity (electromagnetic catheter-tip flow velocity meter), and internal and external phonocardiograms in 25 open-chest dogs. Diastolic time intervals, transmitral pressure gradients (planimetry), maximum mitral flow velocity, and acceleration and deceleration of flow were measured under different loading conditions. It was found that deceleration of mitral flow in early and late diastole is always caused by a negative transmitral pressure gradient. After volume loading, diastolic pressures, positive (forward) and negative (backward) transmitral pressure gradients, and acceleration and deceleration of flow increased, and an S3 or S4 appeared (20:25 dogs). These sounds occurred during the phase of flow deceleration and could be recorded from the chest wall, inside the left ventricle, and directly from the epicardial surface of the freely exposed left ventricular wall. After balloon occlusion of the inferior vena cava (17:25 dogs), the opposite changes were observed and gallop sounds disappeared. The results indicate that the left ventricular pressure rise in response to filling reverses the transmitral pressure gradient and decelerates flow. Deceleration of inflow by the left ventricular wall in early and late diastole may represent a key mechanism in the genesis of S3 and S4.
F Van de Werf; J Minten; P Carmeliet; H De Geest; H Kesteloot
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of clinical investigation     Volume:  73     ISSN:  0021-9738     ISO Abbreviation:  J. Clin. Invest.     Publication Date:  1984 May 
Date Detail:
Created Date:  1984-06-05     Completed Date:  1984-06-05     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  7802877     Medline TA:  J Clin Invest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1400-7     Citation Subset:  AIM; IM    
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MeSH Terms
Blood Flow Velocity*
Blood Pressure
Heart Auscultation*
Heart Sounds*
Mitral Valve

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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