Initial low frequency vibrations of the first heart sound.

Armstrong, T.G.; Gotsman, Mervyn S.

doi:10.1136/hrt.35.7.691

Cited by 6 publications

(4 citation statements)

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“…These observations are in keeping with the concept of isovolumic systole. As detected by the endocardial echo we are, therefore, unable to correlate 'M' with actual movement of the ventricular wall and retract our previous belief that 'M' is caused by muscular movement (Armstrong and Gotsman, 1973). It seems that echocardiographic movement of the posterior wall reflects volume changes in the left ventricle during the ejection phase rather than changes in configuration during isovolumic systole.…”

Section: Resultscontrasting

confidence: 84%

“…Leaflet apposition occurs later, at the time of 'M1' or the closing click of a prosthesis. Tricuspid closure, postulated by Hultgren and Hubis (1965) as a cause of 'M' is unacceptable, since we have previously shown (Armstrong and Gotsman, 1973) that 'M' is present after combined mitral and tricuspid valve replacement and in any event tricuspid closure occurs far too late to be responsible for 'M' (Fig. 9) (Waider and Craige, 1975).…”

Section: Resultsmentioning

confidence: 99%

“…Subsequently, the apposed leaflets billow into the left atrium at the time of the left atrial 'C' wave and cause the mitral sound 'M1' (Lakier et al, 1970;1972a, b). The demonstration that 'M' may occur after mitral valve replacement casts serious doubt upon this explanation (Armstrong and Gotsman, 1973). In support of their concept, however, is the phonocardiographic recording ofa mitral closure sound during ventricular diastole in some cases of severe aortic regurgitation (Wigle and Labrosse, 1965).…”

Section: Resultsmentioning

confidence: 99%

“…The initial low frequency component of the first heart sound has been studied for more than 150 years (Orias, 1936;Eckstein, 1937;Smith et al, 1941;Lakier et al, 1970;Luisada and Argano, 1971;Lakier et al, 1972a, b;Armstrong and Gotsman, 1973). We hope to show that the sound is more than just an abstruse phonocardiographic finding but has clinical significance in that it is responsible for the short crescendo, so-called 'presystolic', murmur of mitral stenosis in atrial fibrillation, as suggested by Tavel and Bonner (Bonner et al, 1976;Tavel and Bonner, 1976).…”

mentioning

confidence: 88%

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Non-invasive observations on initial low frequency vibrations of the first heart sound--correlation with the 'presystolic' murmur in mitral stenosis.

Armstrong¹,

Mitha²,

Matisonn³

et al. 1978

Heart

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SUMMARYThe initial low frequency component of the first heart sound, 'M', has been studied in normal subjects, and in patients with various prosthetic mitral valves and with mitral stenosis, using simultaneous low frequency phonocardiography, echocardiography, and apex cardiography. These techniques showed 'M' to have a constant morphology in preisovolumic systole. In mitral stenosis, 'M' and the preisovolumic 'presystolic' murmur appear to be the same phonocardiographic phenomenon. While 'M' was present in sinus rhythm, augmentation of this normal vibration occurred particularly during the short cycles of atrial fibrillation. Leaflet coaption and movement of the ventricular wall as detected echocardiographically do not appear to play a role in its pathogenesis but the sound could emanate from the ventricular wall as it tautens and decreases its compliance at the onset of systole.The initial low frequency component of the first heart sound has been studied for more than 150 years (Orias, 1936;Eckstein, 1937;Smith et al., 1941;Lakier et al., 1970;Luisada and Argano, 1971;Lakier et al., 1972a, b;Armstrong and Gotsman, 1973). We hope to show that the sound is more than just an abstruse phonocardiographic finding but has clinical significance in that it is responsible for the short crescendo, so-called 'presystolic', murmur of mitral stenosis in atrial fibrillation, as suggested by Tavel and Bonner (Bonner et al., 1976;Tavel and Bonner, 1976). This sound, which occurs near the peak of the R wave of the electrocardiogram and at the crossover point of the left atrial and ventricular pressures, has been termed 'M' by Lakier et al. (1970) and '0' by Luisada and Argano (1971) (Fig. 1). In contrast, the later higher frequency component of the first heart sound (Ml) occurs at the time of the left atrial C wave (Lakier et al., 1972a, b).The cause of 'M' remains controversial. The sound has been attributed to initial coaption of the mitral valve leaflets and the sound 'Ml' to subsequent tensing of the mitral cusps and chordae

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Section: Resultscontrasting

confidence: 84%