Certain abnormal circulatory dynamics of mitral stenosis associated with a major degree of regurgitation

Abstract

1. 1. Electrokymographic and ballistocardiographic technics were employed in the study of the circulatory dynamics of patients with mitral stenosis with and without a major degree of mitral regurgitation. 2. 2. A large early systolic headward ballistic wave has been identified in the ballistocardiogram of patients who have a dynamically significant degree of mitral regurgitation. In two of these patients a deep V-shaped ballistic wave was also observed in early diastole. 3. 3. Clinical observations and various physiologic studies indicate that the forces exerted by the back-flow of blood through the incompetent mitral valves are probably responsible for the production of the headward early systolic wave in the ballistocardiogram. 4. 4. This headward ballistic wave produced by the regurgitant stream through the incompetent mitral valves could have been misinterpreted as an H wave in patients with auricular fibrillation, and perhaps as a notching of the J wave when an atrial H wave is already present. 5. 5. Electrokymograms of the in-flow tract of the left ventricle of patients with mitral stenosis. associated with a major degree of mitral regurgitation shows a rapid lateral movement of the left ventricular wall reaching its peak in early diastole. 6. 6. A similar electrokymographic study made on patients with a “tight” mitral stenosis, with little or no mitral regurgitation, shows a slow lateral movement of the left ventricular wall, reaching its peak just before the onset of the subsequent ventricular systole. 7. 7. Ballistocardiographic and electrokymographic studies may prove to be useful in the study of patients with mitral stenosis in whom a major degree of mitral regurgitation is suspected.