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(Circulation. 1971;44:196.)
© 1971 American Heart Association, Inc.

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Diastolic Heart Sounds and Filling Waves in Coronary Artery Disease

PETER F. COHN M.D.¹; PANTEL S. VOKONAS M.D.¹; RICHARD A. WILLIAMS M.D.¹; MICHAEL V. HERMAN M.D.¹; RICHARD GORLIN M.D.¹

¹ From the Cardiovascular Division, Department of Medicine, Peter Bent Brigham Hospital and Harvard Medical School, Boston, Massachusetts.

One hundred thirty selected patieints with chest pain syndromes were studied by apex- and phonocardiography as well as by cardiac catheterization, selective cine coronary arteriography, and cine left ventriculography. Ninety-three patients had coronary artery disease; 37 did not. Abnormal graphic studies were found in 42 patients with coronary artery disease and three patients with normal coronary arteriograms. These abnormalities correlated well with the presence of elevated left ventricular end-diastolic pressure. Third heart sounds were found less frequently than fourth heart sounds and/or abnormal apexcardiographic a waves, but when present were usually associated with a depressed cardiac index. Diagnostically, over 90% of all patients with chest pain who exhibited graphic abnormalities had significant coronary atherosclerosis. Normal graphic studies did not rule out coronary artery disease, but did indicate adequate left ventricular function since only 5% of patients with normal graphic studies had elevated left ventricular end-diastolic pressure combined with a low cardiac index.

Key Words: Chest pain syndrome • Fourth heart sound • Left ventricular end-diastolic pressure • Coronary arteriography • Third heart sound • Apexcardiographic a wave

Submitted on November 12, 1970
Accepted on April 1, 1971

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