Early changes of mitral valve function in rheumatic heart disease: A clinical, phonocardiographic and electrokymographic study

Abstract

A clinical and graphic study was made of fifty-three cases of rheumatic fever. The patients were studied by means of phonocardiograms and electrokymograms of the left auricle. Thirty patients were studied again after an interval of four to six months. The patients were divided into three groups: (1) those with questionable rheumatic fever, or rheumatic fever without clinical cardiac damage; (2) those during the first attack of rheumatic fever, with clinical cardiac damage; and (3) those with recurrence of rheumatic fever. The phonocardiographic findings are analyzed and discussed. Two types of murmurs were the most common in the early stages of rheumatic fever: (1) A soft, high-pitched, apical, systolic murmur “in decrescendo”; (2) a harsher, at times musical, “diamond-shaped” pulmonic murmur. The mechanism of production of these murmurs is discussed. In the later stages of the disease the apical murmur was often louder while the pulmonic was often less apparent. If healing of the lesions had occurred, both murmurs were less apparent or disappeared. The electrokymogram in a high percentage of cases revealed a pattern due to transmission of intraventricular pressure to the left auricle on account of mitral regurgitation. The various myocardial and valvular elements causing this regurgitation are discussed. The correlation between clinical, phonocardiographic and electrokymographic data proved that these graphic studies are of definite help not only in establishing the diagnosis but also in evaluating the severity of the regurgitation and of the cardiac murmurs. Evaluation of the part played by muscular and valvular factors in causing regurgitation was not possible after a single examination. On the other hand, repeated examinations during and after the active stage frequently permitted such evaluation.