A study of the fourth sound was conducted on 100 normal subjects (ages 1-88 years) and 42 clinical cases with either aortic stenosis, systemic hypertension or coronary heart disease. This study was based on the graphic recognition of a presystolic sound when the tracing was taken with the use of one or more of 5 different high pass filters. Attention was paid to the existence of the fourth sound, its magnitude, and its vibrational frequency. In general it was accepted that a magnitude of 1/2 of the first heart sound or a frequency of 30 Hz denoted a pathologic fourth sound. However, exceptions were found among normal subjects, so that only the combination of the two criteria could be considered highly significant for a pathologic phenomenon (gallop). Patients with aortic stenosis presented an increase in magnitude of the fourth sound but incidence and vibrational frequency were similar to those of controls. Patients with hypertension had a greater incidence of fourth sounds, especially in middle age (100%); middle age patients usually had a greater magnitude while older patients had more often an increase in vibrational frequency. Patients with coronary heart disease (evidence of old infarcts) had an increase in the incidence, magnitude, and vibrational frequency in comparison with controls. These data and the cause of the fourth sound are discussed. The fourth sound has been repeatedly studied in the past, both as an auscultatory finding and a graphic phenomenon. Attempts were made for separating the normal fourth sound from that denoting a pathological phenomenon but, so far, no clear cut criteria for the differentiation have been obtained. We thought, therefore, that a new study was indicated.
Following the observation of an unusual pattern of the first derivative of the impedance cardiogram in cases of bundle branch block, a systematic study was performed both in normal controls and clinical cases. This graphic study was supplemented by the simultaneous recording of the first derivative of an arterial tracing, preferably the indirect aortic pulse at the suprasternal notch. These studies were performed in 70 subjects: 30 normal subjects, 14 cases of right bundle branch block, 14 cases of left bundle branch block, and 12 cases of old infarcts. Out of 30 normal subjects, only 2 old persons showed splintering of the main systolic wave. Both right and left bundle branch blocks had in common either a splitting of this wave in 2 peaks or multiple splintering; however, 4 cases in each type of bundle branch block had a normal pattern. Among old infarcts, 7 had a splitting, 3 had multiple splitting, and 2 had a normal pattern. The derivative of the arterial tracings showed a remarkable similarity with that of the impedance cardiogram, revealing that abnormal left ventricular ejection (dyssynergy) was present in all 3 types of lesion. The first derivative of the impedance cardiogram was often more typical than that of the arterial tracings, because it had fewer secondary vibrations or artifacts. Thus, the former seems more sensitive to diagnosing left ventricular abnormalities of contraction, even when the electrocardiogram is normal.
Ulcerated A theromatous Plaques of the Carotid A rtery Bifurcation• The clinical diagnosis of an ulcerated plaque at the bifurcation of the common carotid artery is based on: mid-carotid bruit, cholesterol or platelet emboli in the retina, transient ischemic attacks particularly with amaurosis fugax, and a reversible neurological deficit.In this series, thrombosis in situ was the final phenomenon in the natural history of the ulcerated plaque.In certain unusual instances it appears that the pathogenesis of a transient ischemic attack is a decrease in cardiac output (fall in systemic blood pressure) leading to a disproportionate decrease in cerebral blood flow in that portion of the arterial system distal to a pathologically narrowed artery.The ultimate diagnosis of an ulcerated plaque depends upon the radiological description at arteriography and upon direct visualization by the surgeon.Surgical treatment at the present time is the therapy of choice. Ulcerated carotid plaques may be bilateral, and, occasionally, are found at other levels than the bifurcation of the common carotid; however, ulcerated plaques were not seen in the intracranial vessels. Additional Key Words cerebral emboli internal carotid artery transient ischemic attacks retinal emboli• Attention has been directed to atheromatous plaques in the first portion of the internal carotid artery as a potential source of retinal and cerebral emboli.1 " These emboli are important in the pathogenesis of transient ischemic attacks (TIA). These may be cholesterol emboli, from the atheromatous portion of a qlaque entering the circulation after there has been a break in the endothelium of the artery, or platelet-fibrin emboli which may arise from a variety of sources including the heart, aorta, cervical arteries, etc.The current practice is to describe stenotic lesions in the internal carotid artery in terms of the degree of stenosis in percent and the length of the lesion in millimeters. An additional criterion is the character of the lesion, that is, ulcerated, smooth or rough. This paper was submitted for publication in June, 1970. 912described the radiological appearance of ulcerated plaques of the carotid arteries. Since 1966 systematic observations of the retina (preradiologically, postradiologically, and surgically) and careful neurological examinations have been correlated with the pathological description of the atheromatous plaques obtained at the time of surgical procedure or autopsy. The purpose of this paper is to evaluate the clinical and radiological methods of diagnosis, to further clarify the criteria for the diagnosis of ulceration of atherosclerotic plaques in the carotid arteries and to correlate and corroborate all of these data with the degree and character of the pathological lesions studied at the time of surgery or autopsy. MethodsThirty-seven patients admitted and studied at the Neurological Institute of Montevideo, Uruguay, constitute the basis for this report. Each patient had: clinical and neurological examinations, ophtha...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.