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Frequency of diastolic third and fourth heart sounds with myocardial ischemia induced during percutaneous coronary

Eunyoung Lee1, Andrew D Michaels, Ronald H Selvester

  • 1Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA 94143-0610, USA. eunylee@gmail.com

Journal of Electrocardiology
|November 18, 2008
PubMed

Insights

New heart sounds (S3 and S4) detected by acoustic cardiography can help diagnose acute myocardial ischemia, even when electrocardiograms (ECG) are inconclusive. This finding improves noninvasive detection of heart attacks.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Acoustic Cardiography

Background:

  • The 12-lead electrocardiogram (ECG) is the standard for diagnosing acute myocardial ischemia but is often nondiagnostic.
  • Nearly 50% of ECGs in patients with chest pain and confirmed myocardial infarction are nondiagnostic.

Purpose of the Study:

  • To investigate the frequency and intensity of diastolic third (S3) and fourth (S4) heart sounds during induced myocardial ischemia.
  • To assess the utility of computerized acoustic cardiography in detecting these heart sounds.

Main Methods:

  • A prospective study involving 24 subjects undergoing percutaneous coronary intervention (PCI).
  • Myocardial ischemia was induced by balloon occlusion during PCI.
  • Diastolic heart sounds (S3 and S4) were measured using computerized acoustic cardiography.

Main Results:

  • A new or increased intensity S3 or S4 sound developed in 67% of subjects during PCI-induced ischemia.
  • Ten of 15 patients (67%) without typical ECG criteria for ischemia also developed these diastolic heart sounds.

Conclusions:

  • Combined use of diastolic heart sounds and standard ECG may enhance the noninvasive diagnosis of myocardial ischemia.
  • Diastolic heart sounds serve as a measurement of ventricular dysfunction, aiding in the prediction of infarction.
Abstract

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