Abstract
Of 400 children under observation during active rheumatic fever, 115, or 29%, presented either an apical diastolic third sound or an early apical diastolic murmur. Of these, 54, or 49%, were found to have an apical diastolic third heart sound and an early diastolic apical murmur in some sequence. The rapid flow of blood from auricles to ventricles during the early diastolic period of the cardiac cycle is thought to be the primary factor responsible for both the third heart sound and the early diastolic murmur. Factors which tend to increase intra-auricular pressure, such as regurgitation at the mitral valve, favor rapid blood flow through the auriculo-ventricular valves and production of these sounds. The importance of the apical diastolic murmur as a sign of myocarditis per se is discussed.
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