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Left heart diastolic extra-sounds. An intracardiac phonocardiographic and hemodynamic study
Insights
Third (S3) and fourth (S4) heart sounds were studied in patients with normal hearts or rheumatic valve disease. S3 sounds occurred mainly in the ventricle during volume overload, while S4 sounds were linked to pressure overload.
Area of Science:
- Cardiology
- Cardiac Auscultation
- Heart Sounds
Background:
- Third (S3) and fourth (S4) heart sounds are important clinical signs.
- Their precise intracardiac origins and correlations with hemodynamic conditions are not fully understood.
- Rheumatic valve disease often presents with abnormal heart sounds.
Purpose of the Study:
- To investigate the intracardiac origin of S3 and S4 heart sounds.
- To correlate the presence and timing of these sounds with specific hemodynamic conditions like volume and pressure overload.
- To examine the relationship between these sounds and left ventricular diastolic pressures.
Main Methods:
- Intracardiac phonocardiography was used to record S3 and S4 sounds in the left ventricle, left atrium, and ascending aorta.
- External phonocardiography was also performed.
- Hemodynamic conditions, including volume and pressure overload, were assessed in 53 patients with normal hearts or rheumatic valve disease.
Main Results:
- S3 sounds were predominantly recorded in the ventricle and associated with volume overload.
- S4 sounds were observed with similar frequency in the left atrium and left ventricle, and more often in pressure overload conditions.
- Minimal correlation was found between the incidence of S3/S4 sounds and left ventricular diastolic pressures; no correlation existed with P-S4 and A2-S3 intervals.
Conclusions:
- Intracardiac phonocardiography helps elucidate the origin of S3 and S4 heart sounds.
- S3 and S4 sounds are linked to distinct hemodynamic states (volume vs. pressure overload).
- The direct correlation between these sounds and diastolic pressures is limited.
Abstract:
In 53 patients with either normal hearts or with rheumatic valve disease (predominantly mitral disease), third and fourth heart sounds (S3, S4), were recorded by intracardiac phonocardiography inthe left ventricle, left atrium and/or ascending aorta. The corresponding sounds were recorded externally in less than one half of the cases only. The S3 was mostly present in the ventricle and in cases of volume overload. The S4 was found with about the same incidence in the left atrium and left ventricle, and more often in cases of pressure overload. The incidence of these sounds showed only a minimal correlation with the left ventricular diastolic pressures, while no correlation at all was found between such pressures and the time intervals P-S4 and A2-S3.