Spectral phonocardiography: problems and prospects in the application of the bell sound spectrograph to phonocardiography.
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Heart Murmurs↗
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[Phonocardiography in veterinary medicine. I. History of the development of phonocardiography and its role in veterinary medicine].
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Animals↗
[Phonocardiography. II. Differential diagnostic value of function phonocardiography].
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Aortic Diseases↗
[Diagnostic significance of functional phonocardiography with vasopressor amines, especially with methoxamine. Functional phonocardiography. (2)].
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Adolescent↗
[Comparative assessment of data of echocardiography and phonocardiography in the diagnosis of heart diseases].
A comparison was made between the echo- and phonocardiographic examinations and the final clinical diagnosis of 85 patients with various cardiac pathology. Echo- and phonocardiography were found to be not alternative, and the less -- contradictory, but mutually supplementing methods. Echocardiography has certain advantages over phonocardiography in the diagnosis of mitral valve defects -- in evaluating the degree of its stenosis and in characterizing the morphological changes of the valve, but it is somewhat inferior in diagnosing mitral insufficiency. In the diagnosis of aortic valve defects phonocardiography appears to be more informative since echocardiography does not always permit to record the state of the aortic valve. Indisputable advantages of echocardiography in the diagnosis of the tricuspid valve defects were revealed. The comparison of the data of echocardiography and phonocardiography permitted to decypher the syndrome of "a late systolic click with a late systolic murmur" that was previously interpreted as a pericardium sound. Besides, the echocardiographic data on the changes in the left ventricular outflow tract help to explain the origin of the spindle-form systolic murmur. So far their interpretation was rather complicated, although they are often seen on phonocardiograms of normal individuals and patients with heart diseases.
Aortic Valve Insufficiency↗
Auscultation in mild mitral regurgitation in dogs: observer variation, effects of physical maneuvers, and agreement with color Doppler echocardiography and phonocardiography.
Observer variation in diagnosing mild mitral regurgitation in dogs by cardiac auscultation was assessed by having 6 veterinarians with different levels of experience examine 57 Cavalier King Charles Spaniels. Comparisons with color Doppler echocardiography and phonocardiography were made, and the effects of 2 physical maneuvers on the auscultatory findings were evaluated. Using mildly diseased dogs, interobserver agreement in diagnosing the presence or absence of left-sided murmurs ranged from 63% to 88%. The agreement with phonocardiography (range, 53-91%) increased with the amount of observer experience. The 2 most experienced observers could discern soft ejection murmurs from regurgitant murmurs and were able to diagnose 89% of the dogs with regurgitant jets larger than 30% of the left atrial area. In general, less experienced observers diagnosed most jets larger than 50%. In many dogs with small jets, no murmur was found by auscultation and phonocardiography. The audibility of mild regurgitation was significantly reduced in dogs that were difficult to auscultate. Early systolic murmurs were typical of mild regurgitation, whereas holosystolic murmurs typified severe regurgitation. In a few dogs, late systolic murmurs alternated with holosystolic murmurs. Systolic clicks were found phonocardiographically in 18 dogs with mild to moderate regurgitation, but the audibility apparently was low. In many mildly affected dogs, physical maneuvers increased murmur intensity. Thus, some form of dynamic auscultation might facilitate the diagnosis of mild regurgitation. Auscultatory findings in mild regurgitation appear to depend on observer experience, circulatory status, and how difficult the dog is to auscultate.
Animals↗
[Dynamic phonocardiography in the study of mitral valve prolapse. Our experience].
The purpose of this paper is to check the usefulness of dynamic phonocardiography for mitral valve prolapse (MVP) diagnosis, especially in apparently silent cases, or with late-systolic click. In fact, possible MVP or mitral valve regurgitation can be shown. 148 patients (58 males, 90 females) have been examined by basal and dynamic phonocardiography and M-echocardiography. Patients were recruited for routine medical examination or during investigations for other causes or to explain evocative MVP troubles. Provocative tests by amyl nitrite, isoproterenol and methoxamine registered a late-systolic click in 17 normal cases and a late-systolic murmur in 22. M-echo demonstrated MVP in 142 cases (96%), with a slight prevalence of late-systolic MVP; tricuspid valve prolapse coexisted in 8 cases and aortic regurgitation in 12. Today echocardiography is the most important examination, but all our data point to the usefulness of dynamic phonocardiography for MVP diagnosis: in our opinion, the integration of both techniques represents the most correct approach.
Adolescent↗
[Left ventricular diastolic function: value of its study with mitral and pulmonary venous Doppler phonocardiography and apexography].
The study of mitral flow and pulmonary venous flow by Doppler provides a non-invasive method of assessing diastolic function. But there are difficulties in differentiating normal pattern from "pseudo-normal" (Appleton Type II) (E/A Mitral > 1). Phonocardiography enables the recording of early (B3) and late (B4) diastolic gallops. The apexogramme enables calculation of the a/H and D/H ratios (amplitude of the "D" wave resulting from rapid early diastolic filling to the total amplitude of the apexogramme). These two techniques record pulsatile phenomena ("pulse waves") arising from variations in intra-left ventricular pressure. They may complete the interpretation of Doppler recordings of velocities of blood flow ("flow waves"). To evaluate the value of each technique, the authors studied left ventricular diastolic function by Doppler phonocardiography and apexography in 60 subjects (38 patients of which 30 with ischaemic heart disease, and 22 healthy subjects). The results showed that increase in velocity and deceleration slope of the Doppler mitral E wave was associated with the presence of a B3 and correlated (r = 0.60; p = 0.0001) with the D/H ratio of the apexogramme. On the other hand, the absence of correlation between the mitral A wave velocity and a B4 associated with an increased a/H ratio enables the differentiation of normal Doppler mitral flow (absence of B4, Doppler a/H ratio < 12%) from pseudo-normal appearances (B4, a/H ratio > 12%). Therefore, the evaluation of diastolic function by Doppler mitral and pulmonary venous flow analysis may be usefully completed by phonocardiography and apexography.
Adult↗
Phonocardiography.
In phonocardiography the second heart sound is important in appraisal of congenital heart disease and pulmonary hypertension because it reflects the duration of right ventricular systoles. The systolic murmur in patients with intracardiac shunt decreases as pulmonary hypertension develops, and may eventually disappear completely as the pulmonary pressure reaches systemic level. Reference tracings in phonocardiography are useful for showing the interrelationship of the various cardiac sounds and murmurs.
Heart Defects, Congenital↗
Nonobstructive hypertrophic cardiomyopathy mimicking mitral stenosis. Documentation by echocardiography, phonocardiography and intracardiac pressure and sound recordings.
The physical findings in hypertrophic cardiomyopathy with left ventricular outflow tract obstruction are well described. In the absence of outflow tract obstruction the findings are less distinctive. There have been several reported cases in which the cardiac findings have suggested the diagnosis of mitral stenosis, In this report we describe a patient whose auscultatory and roentgenographic findings more closely mimicked mitral stenosis. The patient had a loud first heart sound, mitral opening snap and an apical presystolic murmur; left atrial enlargement was present. Noninvasive studies, including phonocardiography, echocardiography and apex cardiography, strongly suggested the correct diagnosis of nonobstructive hypertrophic cardiomyopathy. The diagnosis and unusual auscultatory findings were confirmed by results of cardiac catheterization and intracardiac phonocardiography. The importance of recognizing this syndrome and the use of noninvasive methods to establish the diagnosis are stressed.
Angiocardiography↗
Intracardiac phonocardiography in tricuspid regurgitation: relation to clinical and angiographic findings.
Intracardiac phonocardiograms were obtained from the right atrium in order to study the relation between the clinical signs of tricuspid regurgitation, intracardiac murmurs and the degree of regurgitation demonstrated on right ventriculography with use of a preshaped catheter. In five patients with no heart disease, right ventriculograms showed no evidence of tricuspid regurgitation and intracardiac phonocardiograms in the right atrium demonstrated no murmur. Among 35 patients with valvular heart disease, a Carvallo sign (increased intensity of systolic murmur during inspiration) was present in 19 and absent in 16. All 19 patients with a Carvallo sign had variable degrees of tricuspid regurgitation on right ventriculography, and intracardiac phonocardiograms were positive for tricuspid regurgitation in 18. Among 16 patients with an absent Carvallo sign, neither right ventriculography nor intracardiac phonocardiography was indicative of tricuspid regurgitation in 5. Five patients had 1+ regurgitation and the intracardiac phonocardiogram was positive in three of these five patients. The other six patients showed 3+ to 4+ regurgitation and the intracardiac phonocardiogram was positive for tricuspid regurgitation in all. In conclusion, (1) the Carvallo sign is a reliable indicator of tricuspid regurgitation but its absence does not rule it out, and (2) right ventriculography using a preshaped catheter and intracardiac phonocardiography are useful in detecting clinically unrecognized tricuspid regurgitation.
Adult↗
Non-invasive diagnosis in clinically suspected atrial septal defect of secundum or sinus venosus type. Value of combining chest x-ray, phonocardiography, and M-mode echocardiography.
Twenty-three consecutive patients with clinical (auscultatory and electrocardiographic) signs of uncomplicated atrial septal defect of secundum or sinus venosus type were examined by chest x-ray, phonocardiography, and echocardiography, before right heart catheterisation. Seventeen (74%) had atrial septal defect, two patients (9%) had insignificant pulmonary stenosis, and four subjects (17%) were normal. No false positive diagnosis of atrial septal defect was made by chest x-ray examination, whereas increased vascular markings were incorrectly interpreted as pulmonary congestion in one case. Four patients had x-ray films showing questionable signs of left-to-right shunt. Six of 15 patients with a large left-to-right shunt were correctly selected for surgery based on radiological findings. One false negative but no false positive diagnosis of atrial septal defect was made by phonocardiography. Four cases with and four cases without atrial septal defect were classified as having questionable phonocardiographic signs of atrial septal defect. Echocardiographic distinction between those with atrial septal defect and those without atrial septal defect was correct in all cases; quantitative measurement of left-to-right shunt, however, was unsatisfactory. Combined normal findings by x-ray film and echocardiography appeared adequate in all cases for the exclusion of atrial septal defect (six patients). When the six patients who were correctly identified for surgery from the radiological findings are included, there was a total of 12 patients out of 23 (52%:95% confidence limits 31 to 73%) who were evaluated definitively by the non-invasive tests.
Adolescent↗
Diagnosis of prosthetic mitral valve malfunction with combined echo-phonocardiography.
Fifty-three patients were studied with combined echo-phonocardiography or phonocardiography alone following prosthetic valve replacement. In sixteen of these patients, clinical deterioration developed, and all subsequently underwent cardiac catheterization and/or surgery. Two patients came to autopsy. Included in this group of sixteen patients were five with obstructed prosthesis, six with paravalvular regurgitation, and five with left ventricular dysfunction. Measurements were made of the time interval from the aortic valve closure sound to the peak opening of the mitral prosthesis determined echocardiographically or to the mitral prosthetic opening click (A2-MVO). Echocardiographic studies of left ventricular wall motion were also performed. The A2-MVO interval was significantly shortened (P less than 0.01) with prosthetic valve obstruction (.05 +/- .02 sec) and paravalvular regurgitation (.05 +/- .01 sec) compared with normally functioning prostheses (Starr-Edwards ball valves .10 +/- .02 sec, Lillehei-Kaster tilting disc prostheses .09 +/- .01 sec). Shortening of this interval was not specific for these conditions because it was sometimes shortened with left ventricular dysfunction. Echocardiographic studies of left ventricular wall motion were helpful in distinguishing among prosthetic valve obstruction, paravalvular regurgitation and left ventricular dysfunction. The combined echo-phonocardiographic technique was especially helpful in detecting malfunction of tilting disc prostheses, because the technique enables measurement of the A2-MVO interval in the absence of an audible opening click.
Adult↗
Invasive and noninvasive phonocardiography and orifice-view aortography in the diagnosis of left ventricular outflow obstruction.
Phonocardiography and orifice-view aortography for the detection of valvular and subvalvular stenosis is reviewed. Intracardiac phonocardiography may be useful in detecting a left ventricular outflow tract obstruction, and in distinguishing it from other conditions that can produce an apparent pressure gradient during cardiac catheterization. The frequency analysis of heart sounds on noninvasive phonocardiograms may be useful in identifying subclinical aortic stenosis. Orifice-view aortography can show the anatomy of deformed aortic valves and is useful in measuring the orifice area. In patients with heavily calcified valves, plain orifice-view roentgenograms may enable one to assess the valve area. Therefore the use of these techniques in selected patients may help establish a definitive diagnosis.
Aortic Stenosis, Subvalvular↗
Differential diagnosis of pulmonic stenosis by means of intracardiac phonocardiography.
The purpose of the present paper is to describe the origin of the systolic murmur in pulmonic stenosis and to discuss the diagnostic possibilities of intracardiac phonocardiography. Right heart catheterization was carried out with the aid of a double-lumen A.E.L. phonocatheter on 48 pulmonic stenosis patients with or without associated heart lesions. The diagnosis was confirmed by heart catheterization and angiocardiography in all cases and in 38 of them, by surgical intervention. Simultaneous phonocardiograms were recorded with intracardiac pressure tracings. In valvular pulmonic stenosis, the maximum ejection systolic murmur was localized in the pulmonary artery above the pulmonic valve and well transmitted to both right and left pulmonary arteries, the superior vena cava, and right and left atria. The maximal intensity of the ejection systolic murmur in infundibular stenosis was found in the outflow tract of right ventricle. The contractility of the infundibulum greatly contributes to the formation of the ejection systolic murmur in the outflow tract of right ventricle. In tetralogy of Fallot, the major systolic murmur is caused by the pulmonic stenosis, whereas the high ventricular septal defect is not responsible for it. In pulmonary branch stenosis, the systolic murmur was recorded distally to the site of stenosis. Intracardiac phonocardiography has proved useful for the differential diagnosis of various types of pulmonic stenosis.
Adolescent↗
Usefulness and limitations of precordial phonocardiography and external pulse recordings.
Phonocardiography provides one of a growing list of valuable intermediary studies between physical examination and cardiac catheterization. It not only provides a medium for instruction in physical examination, but also allows one to make certain diagnoses and assess severity of numerous cardiovascular lesions. It is especially valuable in the evaluation of all valvular stenoses, especially aortic stenosis. One can also use phonocardiography for screening and diagnosis of idiopathic hypertrophic subaortic stenosis. It is a helpful adjunct in the study of several congenital abnormalities as well as in the assessment of myocardial function in cardiomyopathies and ischemic heart disease, and may often be decisive in confirming the diagnosis of pericardial constriction.
Adolescent↗
[Clinical features of main and peripheral pulmonary artery stenosis: significance of auscultation and phonocardiography].
Twenty-five patients with main and peripheral pulmonary artery stenosis were studied to determine the most frequently observed diagnostic sign of this abnormality regardless of the underlying etiologies, such as intrinsic or extrinsic narrowing of the pulmonary artery due to tumor, fibromuscular dysplasia, thromboembolism, angitis including the aortitis syndrome (Takayasu arteritis) and a variety of other disease entities. Among a variety of signs and symptoms, we emphasized the importance of cardiac auscultation and phonocardiography, which were often the initial diagnostic clues. The diagnostic features included a systolic murmur of pulmonary arterial origin and the behavior of the splitting of the second heart sound. The systolic murmur was often trans-systolic or continuous. In cases with left-sided cardiac murmurs (Takayasu arteritis, etc), the pulmonary systolic murmurs were not identified by auscultation alone and required phonocardiographic confirmation. In many cases the second heart sound was split and this was sometimes the first clue to the diagnosis. The split intervals varied, but were more marked in cases with pulmonary hypertension, and were accompanied by the accentuated pulmonic component (IIP). Phonocardiographic analysis disclosed that wide splitting was caused by the delayed appearance of IIP as well as the concomitant early appearance of the aortic component (IIA). It was concluded that, although the final etiological diagnosis is not identified, auscultation and phonocardiography provide important clues for further diagnostic and etiological studies of pulmonary artery stenosis.
Adolescent↗
Phonocardiography as a monitor of cardiac performance during anesthesia.
The usefulness of phonocardiography as a monitor of cardiac performance during anesthesia was investigated in six dogs. Anesthetic depression by halothane, isoflurane and nitrous oxide was demonstrated by the phonocardiogram. Likewise, the stimulating effect of dopamine clearly showed in the recordings. Changes in the amplitude of the first heart sound were found to correlate closely with changes in the maximum rate of rise of left ventricular pressure (r = 0.9551, 0.001). P less than 0.001). Simultaneous changes in cardiac output and arterial pressure also occurred. Cardiac depression from anesthetics and/or disease is a major concern during anesthesia. Perioperative phonocardiography, a simple and noninvasive procedure, merits further investigation as a possible monitor of cardiac performance.
Anesthesia↗