PHASES OF DIASTOLE IN VARIOUS SYNDROMES OF MITRAL VALVULAR DISEASE

The diastolic events of the left side of the heart are modified by the obstruction of mitral stenosis and the disordered heart volumes of mitral incompetence, and tracings that illustrate the abnormali-ties have great diagnostic value. Methods developed recently for measuring pressure and movement simultaneously with the heart sounds have allowed records of the patterns of diastolic left heart activity to supplement the physical examination in clinical practice. A degree of confusion has been caused by the use of similar terms in different contexts, and by the failure to recognize the occurrence, significance, or coincidence of certain events. This paper describes the phases of diastole and the syndromes of mitral valvular disease that were observed in the ward and the laboratory, and dis-cusses their bearing upon the genesis of the third heart sound. SUBJECTS AND METHODS Patients with chronic rheumatic heart disease were selected for this study when it was considered that the mitral valvular lesion was the sole or the predominant cause of symptoms and signs. Most had been referred for pre-operative assessment, and presented with atrial fibrillation and pulmonary hypertension. The phonocardiogram was recorded in every case. In nearly 200 the left atrial pressure pulse was the reference tracing. In 34 the heart sounds were recorded simultaneously with the left atrial and the left ventricula