Functional diastolic murmur in 2:1 A-V block.
نویسندگان
چکیده
ONTRARY to the opinion of older clinicians diastolic murmurs are not always organic. This is demonstrated especially by the experiences we made with amplifier auscultation.2) Such non-organic murmurs may be produced by annular incompetence of a valve or by increased blood flow across a normal valve. The murmurs generated by such mechanisms in this report will be designated as " functional " to avoid confusion with organic and adventitious murmurs. Special kinds of functional diastolic murmurs are for instance Graham Steell murmur in patients with mitral stenosis and Austin Flint murmur associated with aortic valvular insufficiency. Since 1961 another mechanism of generation of functional diastolic murmurs across intact valves purely by means of hemodynamic alterations due to tachycardia was described by Wolf.3) He found such murmurs in healthy children with tachyeardia. When the heart rate became normal the murmur disappeared. This was confirmed later on by Zeh4) in adults. Two theories have been proposed to explain the mechanism of the production of Wolf's murmur, (1) when the rapid filling time and the augmentation of inflow velocity by auricular contraction coincide. This may be a true functional " stenosis " of either or both A-V valves. (2) The other possibility is a form of summation gallop. But since the murmur lasts for about 0.20 sec. the IV sound should follow the III sound immediately. That means it is more a follow-up than a summation gallop. A 58-year-old diabetic woman with arteriosclerotic coronary heart disease was admitted to our hospital because of a low pulse rate. There was no history of rheumatic fever, chorea, or heart disease. On physical examination the heart rate was 40/min. The blood pres-
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عنوان ژورنال:
- Japanese heart journal
دوره 6 4 شماره
صفحات -
تاریخ انتشار 1965