Physical Signs, Apexcardiography, Phonocardiography, and Systolic Time Intervals in Angina Pectoris

Coronary artery disease and angina pectoris are frequently associated with disordered myocardial function which may cause abnormalities in precordial motion, heart sounds, and/or systolic time intervals. The pathophysiologic basis for these abnormalities has been studied by correlating them with more direct measurements of myocardial function. Large a waves on the apexcardiogram and atrial gallops are related to accentuated left ventricular a waves which reflect diminished left ventricular compliance. Uncoordinated left ventricular contraction (asynergy) may cause abnormal systolic motion which can sometimes be recorded on the apexcardiogram. Ventricular (early diastolic) gallops in coronary artery disease are usually associated with extensive obstructive lesions, left ventricular asynergy, and a low cardiac output. Transient paradoxic splitting of the second sound in angina pectoris has been reported though rarely documented by phono-cardiography. Mitral insufficiency due to papillary muscle dysfunction ...