First heart sound and ejection sounds. Echocardiographic and phonocardiographic correlation with valvular events.

Abstract To provide additional information on the relation of valvular events to the principal components of the first heart sound (S 1 ), combined echocardiograms and phonocardiograms were recorded in 49 subjects, chosen because of audible splitting of S 1 or a combination of S 1 and an ejection sound. The subjects included 14 normal persons, 16 patients with a variety of predominantly right-sided heart conditions, 7 with mitral stenosis, 3 with pulmonary stenosis and 9 with aortic valve disease or systemic hypertension. A precise relation was found between completion of closure of the atrioventricular (A-V) valves manifested in the echocardiogram and the high-frequency components of S 1 (M 1 and T 1 . The average time from the Q wave of the electrocardiogram to M 1 was 0.06 ± 0.003 second and the Q-T 1 , interval was 0.09 ± 0.002 second. In mitral stenosis the Q-M 1 interval was delayed to 0.10 ± 0.005 second, resulting in some instances in reversed splitting of S 1 . In pulmonary stenosis, the ejection sound occurred 0.10 ± 0.003 second from the Q wave. In 7 of the 16 patients with various right-sided abnormalities, but without valvular stenosis, an ejection sound of pulmonary origin occurred 0.18 ± 0.012 second from the Q wave. In the nine patients with aortic valve disease or systemic hypertension, the time from the Q wave to the aortic ejection sound was 0.13 ± 0.004 second. With only two exceptions the ejection sounds of aortic and pulmonary origin coincided exactly with the achievement of a fully opened position of the respective semilunar valve. Our findings support the postulate that M 1 , T 1 and the ejection sounds occur in association with closing or opening of valves with consequent sudden deceleration or acceleration of a column of blood that, in turn, results in vibrations of the cardiohemic system and audible sounds.