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Biomedical subjects

M E Tavel

Publications and source records attributed to M E Tavel.

At least 19 recordsLinked to original sources
PubMed1996

The appearance of gallop rhythm after exercise stress testing.

BACKGROUND AND HYPOTHESIS: Although it is generally assumed that the appearance of an early diastolic gallop, or third heart sound, appearing immediately after exercise during treadmill stress testing, indicates the presence of serious myocardial disease, no systemically collected data are available to test this hypothesis. METHODS: The author performed auscultation on 3,679 patients undergoing routine treadmill testing together with thallium-201 perfusion scans. Exercise-induced diastolic sounds were related to the available clinical information and electrocardiographic and nuclear test results. These findings were compared with those of 665 randomly selected patients undergoing stress testing in whom such sounds were absent. RESULTS: A total of 165 patients had audible third heart sounds (Group 1). In comparison with those patients lacking such sounds (Group 2), there was a considerably greater prevalence of myocardial scarring (68.5 vs. 26.9%), abnormal lung uptake of thallium (40 vs. 12.8%), diabetes mellitus (20.6 vs. 6.2%), and left bundle-branch block on the resting electrocardiogram (ECG) (15.1 vs. 1.2%). In addition, 65 patients (39.3%) had dilatation of the left ventricle after exercise; 31 (18.8%) of these were also dilated at rest, but only 2 (1.2%) had a drop in blood pressure during stress. In those individuals also subjected to nuclear ventriculography, the average resting ejection fraction was 35%. Estimated exercise capacity was generally reduced in Group 1 (average peak of 6.6 METs), but 29 (17.6%) exceeded 9 METs. Sensitivity and specificity of electrocardiographic ST depression were relatively poor in the detection of perfusion defects within this group (36 and 62%, respectively). Of the 39 patients in Group 1 with a normal resting ECG, 19 (48.7%) had scar (usually posterior or lateral) on nuclear scans. In an additional 10 of this group, nuclear evidence of ischemia (often extensive) was found. CONCLUSIONS: An early or mid-diastolic gallop sound developing after exercise virtually always signifies myocardial disease with reduced myocardial function. Common associated findings are prior infarction (with or without associated ischemia), diabetes, and left bundle-branch block. When found in the presence of a normal resting ECG, this sound commonly signals the presence an occult left ventricular scar and, less commonly, extensive myocardial ischemia. In those patients manifesting such sounds, electrocardiographic ST changes in response to exercise appear limited in the detection of coronary ischemia.

Bundle-Branch Block↗
PubMed1994

Enhanced auscultation with a new graphic display system.

BACKGROUND: To provide an objective method to support and teach auscultation, a new portable system (graphic display system) was evaluated for graphic display and printing of heart sounds. METHODS: Ninety-one patients from three institutions, with a variety of heart sound abnormalities, were studied by two examiners. A graphic recording was made in each and compared with the auscultatory findings. RESULTS: The findings of the graphic system confirmed the auscultatory impressions of both examiners in 77 (85%) of the 91 cases. Brief sound transients, such as split second sounds and ejection sounds, third heart sounds, and prosthetic opening and closing sounds, were all regularly recorded with the graphic system, often allowing resolution when examiners were in disagreement. Graphic recordings commonly were at variance with examiners in detecting fourth sounds, possibly because of examiners' difficulty in distinguishing these from split first sounds as well as limitations of the graphic system itself. High-pitched murmurs of low intensity (< grade 2), as exemplified by those of aortic and mitral regurgitation, were occasionally missed by the graphic system, probably because of baseline interference by background noise. CONCLUSIONS: The graphic display system can often provide more information than can be obtained by standard auscultation alone, especially in the detection of low-frequency and multiple sounds, and in the accurate timing of intervals. It is often unable to detect soft high-frequency murmurs. Permanent records allow for more objective comparison of the auscultatory findings of various examiners at different times. This system provides an excellent means by which auscultation skills may be taught or enhanced, especially since its speed and portability allow immediate feedback for comparison with auditory perceptions.

Computer Graphics↗
PubMed1987

Audibility of the fourth heart sound. Relationship to presence of disease and examiner experience.

To determine the meaning of an audible fourth heart sound (S4), 51 subjects (21 normal and 30 abnormal persons), aged between 38 and 74 years (mean, 55.4 years), were examined by nine "blinded" physicians (four cardiologists, five house staff officers). Audibility scores were compared with phonocardiographic, echocardiographic, and hemodynamic measurements. An S4 was recorded graphically in 35 (68.6%) of all 51 subjects and splitting of the first sound (S1), in 37 subjects (72.5%). The abnormal group did not differ significantly from the normal subjects in incidence of recordable S4 or splitting of S1. Audibility of S4, however, correlated with its recorded amplitude, size, and palpability of the presystolic apical impulse, left ventricular systolic and diastolic diameters, and history of myocardial infarction. Despite variation among examiners, house staff officers were likelier than cardiologists to believe an S4 present even in cases lacking a recordable S4 and in normal subjects and were more apt to believe an S4 present when splitting of S1 was identified graphically. We conclude that an audible S4 continues to provide evidence for cardiac disease, and that increasing examiner experience renders this finding fairly specific. Less experienced examiners are likelier to confuse splitting of S1 with the S4, suggesting that training should be focused on means to improve this differentiation.

Adult↗
PubMed1985

Strategy for the detection and management of coronary artery disease. "Physiology before anatomy".

A strategy for the diagnosis of ischemic heart disease should be based on knowledge of the prevalence of the disease in population subgroups. Asymptomatic patients should not be routinely screened. Asymptomatic patients or patients with nonanginal chest pain should have both a positive exercise electrocardiogram and stress nuclear scan before a diagnosis of ischemic heart disease is justified or arteriography is recommended. Patients with atypical angina should be evaluated with exercise radionuclide ventriculography. Coronary arteriography is rarely needed for diagnosis and is most properly used as a preoperative evaluation of a patient who has symptoms uncontrolled by medical management, or in whom a significant amount of myocardium is at risk as determined by physiologic testing with exercise electrocardiography or stress nuclear techniques.

Angina Pectoris↗
PubMed1984

Spectral analysis of heart sounds: relationships between some physical characteristics and frequency spectra of first and second heart sounds in normals and hypertensives.

Frequency analysis of heart sounds has been gaining recognition as a possible indicator of several heart and valve diseases, although a comprehensive study of normal heart sounds has not been published. Relating the frequency content of normal heart sounds to certain physical characteristics surrounding the generation of these sounds could lead to a valuable diagnostic tool and give a better understanding of the mechanism of heart sounds production. In this study, the first and second heart sounds from seventy-four normal, and seven hypertensive volunteers were recorded, digitized and analysed using a Fast Fourier Transform algorithm. Statistical analysis was used to relate physical characteristics (sex, blood pressure, and body surface area) of the subjects to the frequency content of normal heart sounds and to compare normal and hypertensive heart sounds. Statistical analysis showed that the major concentration of energy, for both first heart sound (S1) and second heart sound (S2), is below 150 Hertz (Hz) which may indicate that both sounds are caused by vibrations within the same structure, possibly the entire heart. However S2 spectra have greater amplitude than S1 spectra above 150 Hz, which may be due to vibrations within the aorta and pulmonary artery. Relationships observed between body surface area, sex, blood pressure, and the frequency content of heart sounds indicate that as heart size increases, the amplitude of the frequency coefficients above 150 Hz decreases. These observations were more identifiable in the S1 spectra than in the S2 spectra, possibly because the S2 higher frequency components may mask subtle changes in the S2 spectra caused by heart size changes. However, when the changes in heart size are significant, as in hypertension or increased body surface area, trends in the S2 spectra can be observed.

Adolescent↗