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July 3, 1972, Vol 221, No. 1 >
ARTICLE | July 3, 1972

Audibility of the Fourth Heart Sound: Title and subTitle BreakA Prospective, "Blind" Auscultatory and Polygraphic Investigation FREE

Eulogio H. Rectra, MD; Abdul H. Khan, MD; Veronica M. Pigott, MS; David H. Spodick, MD
[+] Author Affiliations

Reprint requests to 170 Morton St, Boston 02130 (Dr. Spodick).

Read in part before the American Heart Association 44th scientific sessions, Anaheim, Calif, Nov 10, 1971.


JAMA. 1972;221(1):36-41. doi:10.1001/jama.1972.03200140024007
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References

An auscultatory search for a fourth heart sound (S4) was performed by two independent "blind" auscultators who did not know the medical status of 196 consecutively examined subjects, ages 50 to 80 years. Phonocardiograms (PCGs) and other tracings taken after recording the results were measured by a third observer who was also "blind." Results of this investigation indicate that any tendency for rapid completion of atrial excitation and early onset of S4 appears to determine the auscultatory audibility of the fourth heart sound. Conversely, a tendency to later completion of atrial excitation and a later onset of S4 will make it auscultatorily inaudible, although recordable even at considerable amplitude by PCG. The relative amplitude and frequency of S4 were not significantly related to its audibility. The presence or absence of disease was not significantly related to the presence or absence of S4 by PCG or to its audibility when present.

REFERENCES

1 +
Weitzman D:  The mechanism and significance of auricular sound . Brit Heart J 17:70-78, 1955;.
2 +
Kincaid-Smith P, Barlow J:  The atrial sound in hypertension and ischemic heart disease . Brit Heart J 21:479-491, 1959;.
3 +
Grayzel J:  Gallop rhythm of heart: I. Atrial gallop, ventricular gallop and systolic sound . Amer J Med 28:578-592, 1960;.
4 +
Lewis DH, Deitz GW, Wallace JD, et al:  Intercardiac phonocardiography in man . Circulation 16:764-775, 1957;.
5 +
Crevasse L, Wheat M, Wilson J, et al:  The mechanism of generation of the third and fourth heart sound . Circulation 25:635-642, 1962;.
6 +
Braunwald E, Frahm C:  Studies of Starling's law of the heart: Observations on the hemodynamic function of the left atrium in man . Circulation 24:633-642, 1961;.
7 +
Kuo P, Hildreth E, Kay C:  The mechanism of gallop sounds, studied with the aid of electrokymograph . Ann Intern Med 35:1306-1317, 1951;.
8 +
Shah P, Gramiak R, Kramer D, et al:  Determinants of atrial (S,) and ventricular (S3) gallop sounds in primary myocardial disease . New Eng J Med 278:753-758, 1968;.
9 +
Tafur E, Cohen L, Levine H:  The apexcardiogram in left ventricular outflow tract obstruction . Circulation 30:392-399, 1964;.
10 +
Eddleman E Jr:  The kinetocardiogram: Ultra low-frequency precordial movements , in Luisada A (ed): Examination of the Cardiac Patient . New York, McGraw-Hill Book Co, 1965;, pp 3-63.
11 +
Goldblatt A, Aygen M, Braunwald E:  Hemodynamic-phonocardiographic correlations of the fourth heart sound in aortic stenosis . Circulation 26:92-98, 1962;.
12 +
Benchimol A, Dimond E:  Apexcardiogram in ischemic heart disease . Brit Heart J 24:581-594, 1962;.
13 +
Evans W:  Triple heart rhythm . Brit Heart J 5:205-228, 1943;.
14 +
Craige E:  Gallop rhythm . Progr Cardiovasc Dis 10:246-261, 1967;.
15 +
Krossman CE, Berger AR, Brumlik J, et al:  The rate of conduction in human atrium . J Clin Invest 26:1186, 1947;.
16 +
Ruch TC, Patton HD: Physiology and Biophysics . Philadelphia, WB Saunders Co, 1965;.
17 +
Hamilton WF, Dow P: Handbook of Physiology: II. Circulation . Washington, DC, American Physiological Society, 1962;, vol 1, chap 21.
18 +
Scher AM, Rodriguez MI, Liikane J, et al:  The mechanism of atrio-ventricular conduction . Circ Res 7:54-61, 1959;.
19 +
Katz L: Clinical Electrocardiography . Philadelphia, Lea & Febiger, 1958;.
20 +
Perry E, Mounsey P:  Gallop sounds in hypertension and myocardial ischemia modified by respiration and other maneuvers . Brit Heart J 23:393-404, 1961;.

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1 +
Weitzman D:  The mechanism and significance of auricular sound . Brit Heart J 17:70-78, 1955;.
2 +
Kincaid-Smith P, Barlow J:  The atrial sound in hypertension and ischemic heart disease . Brit Heart J 21:479-491, 1959;.
3 +
Grayzel J:  Gallop rhythm of heart: I. Atrial gallop, ventricular gallop and systolic sound . Amer J Med 28:578-592, 1960;.
4 +
Lewis DH, Deitz GW, Wallace JD, et al:  Intercardiac phonocardiography in man . Circulation 16:764-775, 1957;.
5 +
Crevasse L, Wheat M, Wilson J, et al:  The mechanism of generation of the third and fourth heart sound . Circulation 25:635-642, 1962;.
6 +
Braunwald E, Frahm C:  Studies of Starling's law of the heart: Observations on the hemodynamic function of the left atrium in man . Circulation 24:633-642, 1961;.
7 +
Kuo P, Hildreth E, Kay C:  The mechanism of gallop sounds, studied with the aid of electrokymograph . Ann Intern Med 35:1306-1317, 1951;.
8 +
Shah P, Gramiak R, Kramer D, et al:  Determinants of atrial (S,) and ventricular (S3) gallop sounds in primary myocardial disease . New Eng J Med 278:753-758, 1968;.
9 +
Tafur E, Cohen L, Levine H:  The apexcardiogram in left ventricular outflow tract obstruction . Circulation 30:392-399, 1964;.
10 +
Eddleman E Jr:  The kinetocardiogram: Ultra low-frequency precordial movements , in Luisada A (ed): Examination of the Cardiac Patient . New York, McGraw-Hill Book Co, 1965;, pp 3-63.
11 +
Goldblatt A, Aygen M, Braunwald E:  Hemodynamic-phonocardiographic correlations of the fourth heart sound in aortic stenosis . Circulation 26:92-98, 1962;.
12 +
Benchimol A, Dimond E:  Apexcardiogram in ischemic heart disease . Brit Heart J 24:581-594, 1962;.
13 +
Evans W:  Triple heart rhythm . Brit Heart J 5:205-228, 1943;.
14 +
Craige E:  Gallop rhythm . Progr Cardiovasc Dis 10:246-261, 1967;.
15 +
Krossman CE, Berger AR, Brumlik J, et al:  The rate of conduction in human atrium . J Clin Invest 26:1186, 1947;.
16 +
Ruch TC, Patton HD: Physiology and Biophysics . Philadelphia, WB Saunders Co, 1965;.
17 +
Hamilton WF, Dow P: Handbook of Physiology: II. Circulation . Washington, DC, American Physiological Society, 1962;, vol 1, chap 21.
18 +
Scher AM, Rodriguez MI, Liikane J, et al:  The mechanism of atrio-ventricular conduction . Circ Res 7:54-61, 1959;.
19 +
Katz L: Clinical Electrocardiography . Philadelphia, Lea & Febiger, 1958;.
20 +
Perry E, Mounsey P:  Gallop sounds in hypertension and myocardial ischemia modified by respiration and other maneuvers . Brit Heart J 23:393-404, 1961;.

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