Combined apexcardiography and phonocardiography in investigation of heart disease in the elderly.

Abstract

Simultaneous apexcardiography and phonocardiography have been used in investigating over 200 elderly hospital patients with cardiac disorders. Qualitative changes in the apexcardiogram generally denote the effects of left ventricular hypertrophy or mitral valve disease. Quantitative abnormalities include prolongation of the atrial electromechanical interval in some cases of first degree heart block and four possible changes in left bundle branch block: prolongation of the ventricular electromechanical interval, of the pre-ejection period, of both, or of neither. Analysis of ventricular ectopic beats shows that the pre-ejection period is often prolonged and the left ventricular ejection time shortened in comparison with sinus beats. In aortic stenosis the upstroke of the arterial pulse is frequently delayed, while in aortic valvular sclerosis without stenosis the upstroke time has generally been normal. Provided its limitations are recognized, apexcardiography can be a useful adjunct to investigation of the heart in the elderly. Its value is enhanced by its non-invasive character and the lack of discomfort or disturbance to the patient.