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Sounds and murmurs produced by auricular systole
In order to interpret correctly rhe signi Lance uf a -;uppose,l :~peni~,: *ii~~~ of the mitral valve when graphic methods are use,L, it is necessary +o record Otherwise it is rhc heart sounds simultaneously with the optical venous pulse. impossible to determine accurately the exact moment of occurrence of the @ori:!dardiographic accidents and, consequently, to distinguish the opening snap frony -L doubling of t.he second sound or from any other of the sounds which oxnr early during diastole under normal or pathological conditions. Braxnwell,
Crighton:
Gallop
Rhythm.
Quart.
.J. Neck.
4:
149, 1935.
Presystolie gallop is a sign of great clinical significance, antl, for th:> readoil alone, it should be clea.rly distinguished from all other types of triple rhythm. n~dvanced Gallop rhythm occurs most frequently in patient s with hypertension, coronary disease, or acute inflammatory lesions of the heart. It is an cstremels grayJc sign in prognosis. Very few patients live for more than two yeai’s after True gallop rhythm is not casually related to A-‘1’ ,:alIop rhythm develops. block nor to bundle-branch block. Auricular contraction, tachycardia, and a failing heart are the factors essential to the production of gallop. It is suggested that the additional impulse in gallop rhythm is p~oClu~*~rl by *odden distention of the ventricle and the additional 8ound, by vibrations of thkt \-entricular wall, both these phenomena being due to an abnormally raljid rate >f filling of the ventricle when the myocardium is lacking in tone. EWamwell, J. Ned.
Crighton: 4: 139,
Sounds 1935.
and Murmurs
Produce8d
by snricular
Systole.
Quarr.
Records of the heart sounds in a ease of Graves' disease wilh partiai ?:oa~rj3lock show that the initial vibrations of the Srst heart sound in normal cgcle~ bear the same time relation to the P-vace in the oleetrocardiogram as do th;a \iibrations of the auricular phonogram to the blocked auricnlar heats. These twu series of vibrations are also similar in form. When the P-R interval is prolonged, the complete series of x-ibratioiis in the phonogram ; auricular phonogram precedes the larger vibrations of the ventricular 5ut when the P-R interval is of normal duration, the two series of vihmticns 0 verlap. These observations prove that in this c-asc the initial vibrations of tkc, fir:,: ‘Icart sound are produced by the auricle an11 not by the ventricle. It is suggcstc~I That the initial vibrations seen in records obtained from normal subjects ma! also be attributable to auricular aystole. These initiai vibrations are, h(Jrt-evuy, usually of such small amplitude that they fail to reach thu thresEo!d of audi5ilitp. It is suggested that the similarity betwtcn the first heart sound in hypcrrhyroidism, in certain athletes, in sOme cases of congenital heart disease, and in some patients with high blood pressure, on one hand, and the first heart soxu!l a.:ld presystolic murmur of mitral stenosis, on ,the other hand, mar Y be 11ur .to an ” increased velocity of the blood flow through the nxtral or~hcc when the auriculer muscle is hypertrophied. The late development of the auricular sound s-uggests that it is not cntirelv due to a muscle tone but in part at least to vibrations set up ‘by The hiooc? cjectcd by the auricle. R,ecords of heart sounds and murmurs in two cases of mitral stenosis eom $leated by partial heart-block showed that the time rela.tions of the auridw aystolie element of the mitral murmur wcrc strictly anaIogous to Those of tFe naricular component of the first heart sound in the ea.se of hypertbyroid.ism d.:scribed.
704
THE
AMERICAN
HEART
JOURNAL
There is a striking variation in the intensity of the auriculosystolic murmur in different cycles of these records. When auricular systole occurs early in diastole, the murmur is loud; but when it occurs at the end of a prolonged diastole, it may be so faint that it fails to reach the threshold of audibility. Its absence in cycles following a blocked auricular beat is explained by the inability of the engorged ventricle to accept the auricular output. It is suggested that summation of the systolic murmur and the initial vibrations account for the accentuation of the first stenosis.
terminal vibrations of produced by ventricular heart sound in patients
the auriculosystole may with mitral
Wilson, May G., Ingerman, Eugenia, DuBois, Robert O., and Speck, Benjamin The Relation of Upper Respiratory Infections to Rheumatic Fever in MCI,.: I. The Significance of Hemolytic Streptococci in the Pharyngeal Children. Flora During Respiratory Infection. J. Clin. Investigation 14: 325, 1935. There are presented investigations conducted over comprising epidemiological, bacteriological, and clinical of rheumatic children observed in the homes, hospital cot.tages. Two hundred twenty-two ambulatory years old experienced 783 respiratory (for a two-year period of observation, the rheumatic attacks were preceded fection.
a period studies wards,
of several years of a large group and convalescent
rheumatic subjects from five to fifteen infections and 401 rheumatic recurrences 1930 to 1932). Less than 10 per cent of within three weeks by a respiratory in-
Of a total of 123 rheumatic subjects under close observation for twelve months, September, 1933, to September, 1934, 98 per cent suffered 649 attacks of respiratory infection, of which 353 were associated with the presence of hemolytic streptococci in the throat flora. Eighty-four per cent of the respiratory infections were not associated with rheumatic activity. Forty-nine per cent of the subjects experienced quiescent interval, subsequent to ” streptococcal ” 13.5 per cent of the rheumatic episodes.
139 rheumatic episodes; a respiratory infection, preceded
Sixty-two rheumatic subjects were under daily observation at the convalescent During three epidemics of respiratory cottages for a two-to-twelve-month period. infection associated with a predominance of hemolytie streptococci in the pharyngeal flora, there was no appreciable increase of rheumatic activity. Rheumatic subjects experienced an average fection as compared with an average of three their respective households. During the spring flora of the majority
of 1934 hemolytic of the rheumatic
of five attacks of respiratory for the nonrheumatic children
streptococci appeared in and nonrheumatic subjects.
During this season of its highest incidence, hemolytic streptococci in the pharyngeal flora of 50 per cent cf the rheumatic subjects 40 per cent during respiratory infections, and 10 per cent during tivity. The evidence presented does not support relationship between respiratory infections The authors ’ of the presence ing respiratory based solely on
observations or absence infections. bacteriological
the conception and rheumatic
the
inof
pharyngcal
predominated during health, rheumatic ac-
of a specific etiologieal fever in children.
would tend to minimize the diagnostic significance of hemolytie streptococci in the pharyngeal flora durThe designation streptococcal respiratory infection, findings, would not appear to be justified.
Crighton:
Gallop
Rhythm.
Quart.
.J. Neck.
4:
149, 1935.
Presystolie gallop is a sign of great clinical significance, antl, for th:> readoil alone, it should be clea.rly distinguished from all other types of triple rhythm. n~dvanced Gallop rhythm occurs most frequently in patient s with hypertension, coronary disease, or acute inflammatory lesions of the heart. It is an cstremels grayJc sign in prognosis. Very few patients live for more than two yeai’s after True gallop rhythm is not casually related to A-‘1’ ,:alIop rhythm develops. block nor to bundle-branch block. Auricular contraction, tachycardia, and a failing heart are the factors essential to the production of gallop. It is suggested that the additional impulse in gallop rhythm is p~oClu~*~rl by *odden distention of the ventricle and the additional 8ound, by vibrations of thkt \-entricular wall, both these phenomena being due to an abnormally raljid rate >f filling of the ventricle when the myocardium is lacking in tone. EWamwell, J. Ned.
Crighton: 4: 139,
Sounds 1935.
and Murmurs
Produce8d
by snricular
Systole.
Quarr.
Records of the heart sounds in a ease of Graves' disease wilh partiai ?:oa~rj3lock show that the initial vibrations of the Srst heart sound in normal cgcle~ bear the same time relation to the P-vace in the oleetrocardiogram as do th;a \iibrations of the auricular phonogram to the blocked auricnlar heats. These twu series of vibrations are also similar in form. When the P-R interval is prolonged, the complete series of x-ibratioiis in the phonogram ; auricular phonogram precedes the larger vibrations of the ventricular 5ut when the P-R interval is of normal duration, the two series of vihmticns 0 verlap. These observations prove that in this c-asc the initial vibrations of tkc, fir:,: ‘Icart sound are produced by the auricle an11 not by the ventricle. It is suggcstc~I That the initial vibrations seen in records obtained from normal subjects ma! also be attributable to auricular aystole. These initiai vibrations are, h(Jrt-evuy, usually of such small amplitude that they fail to reach thu thresEo!d of audi5ilitp. It is suggested that the similarity betwtcn the first heart sound in hypcrrhyroidism, in certain athletes, in sOme cases of congenital heart disease, and in some patients with high blood pressure, on one hand, and the first heart soxu!l a.:ld presystolic murmur of mitral stenosis, on ,the other hand, mar Y be 11ur .to an ” increased velocity of the blood flow through the nxtral or~hcc when the auriculer muscle is hypertrophied. The late development of the auricular sound s-uggests that it is not cntirelv due to a muscle tone but in part at least to vibrations set up ‘by The hiooc? cjectcd by the auricle. R,ecords of heart sounds and murmurs in two cases of mitral stenosis eom $leated by partial heart-block showed that the time rela.tions of the auridw aystolie element of the mitral murmur wcrc strictly anaIogous to Those of tFe naricular component of the first heart sound in the ea.se of hypertbyroid.ism d.:scribed.
704
THE
AMERICAN
HEART
JOURNAL
There is a striking variation in the intensity of the auriculosystolic murmur in different cycles of these records. When auricular systole occurs early in diastole, the murmur is loud; but when it occurs at the end of a prolonged diastole, it may be so faint that it fails to reach the threshold of audibility. Its absence in cycles following a blocked auricular beat is explained by the inability of the engorged ventricle to accept the auricular output. It is suggested that summation of the systolic murmur and the initial vibrations account for the accentuation of the first stenosis.
terminal vibrations of produced by ventricular heart sound in patients
the auriculosystole may with mitral
Wilson, May G., Ingerman, Eugenia, DuBois, Robert O., and Speck, Benjamin The Relation of Upper Respiratory Infections to Rheumatic Fever in MCI,.: I. The Significance of Hemolytic Streptococci in the Pharyngeal Children. Flora During Respiratory Infection. J. Clin. Investigation 14: 325, 1935. There are presented investigations conducted over comprising epidemiological, bacteriological, and clinical of rheumatic children observed in the homes, hospital cot.tages. Two hundred twenty-two ambulatory years old experienced 783 respiratory (for a two-year period of observation, the rheumatic attacks were preceded fection.
a period studies wards,
of several years of a large group and convalescent
rheumatic subjects from five to fifteen infections and 401 rheumatic recurrences 1930 to 1932). Less than 10 per cent of within three weeks by a respiratory in-
Of a total of 123 rheumatic subjects under close observation for twelve months, September, 1933, to September, 1934, 98 per cent suffered 649 attacks of respiratory infection, of which 353 were associated with the presence of hemolytic streptococci in the throat flora. Eighty-four per cent of the respiratory infections were not associated with rheumatic activity. Forty-nine per cent of the subjects experienced quiescent interval, subsequent to ” streptococcal ” 13.5 per cent of the rheumatic episodes.
139 rheumatic episodes; a respiratory infection, preceded
Sixty-two rheumatic subjects were under daily observation at the convalescent During three epidemics of respiratory cottages for a two-to-twelve-month period. infection associated with a predominance of hemolytie streptococci in the pharyngeal flora, there was no appreciable increase of rheumatic activity. Rheumatic subjects experienced an average fection as compared with an average of three their respective households. During the spring flora of the majority
of 1934 hemolytic of the rheumatic
of five attacks of respiratory for the nonrheumatic children
streptococci appeared in and nonrheumatic subjects.
During this season of its highest incidence, hemolytic streptococci in the pharyngeal flora of 50 per cent cf the rheumatic subjects 40 per cent during respiratory infections, and 10 per cent during tivity. The evidence presented does not support relationship between respiratory infections The authors ’ of the presence ing respiratory based solely on
observations or absence infections. bacteriological
the conception and rheumatic
the
inof
pharyngcal
predominated during health, rheumatic ac-
of a specific etiologieal fever in children.
would tend to minimize the diagnostic significance of hemolytie streptococci in the pharyngeal flora durThe designation streptococcal respiratory infection, findings, would not appear to be justified.