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Spectral energy of the 1st heart sound in acute myo cardial ischemia a correlation with electro cardiographic hemodynamic and wall motion abnormalities

, : Spectral energy of the 1st heart sound in acute myo cardial ischemia a correlation with electro cardiographic hemodynamic and wall motion abnormalities. Circulation 57(3): 593-598

First heart sound (S1) energy spectra in isovolumic systole, hemodynamics and angiographic left ventricular wall motion (LVWM) at rest and with atrial pacing were compared in 27 patients who underwent diagnostic cardiac catheterization and angiography because of chest pain. Patients (18) had coronary artery disease (CAD) and 9 patients, normal coronary arteries. Of the 18 CAD patients, 61% had a mean reduction in the spectral energy of S1 of 6.5 .+-. 1.4 (SEM [standard error of the mean]) dB below control (-52%), during interruption of ischemic stress of rapid atrial pacing, compared to only 1 of 9 patients without CAD (P < 0.05). Only 5 CAD patients had an abnormal rise (.gtoreq. 5 mm) in left ventricular end-diastolic pressure (LVEDP) either during or on interruption of pacing, and 6 had ischemic ST-segment depression .gtoreq. 0.1 mV in the ECG. Two patients free of CAD had an abnormal increase in LVEDP, and none had ECG evidence of ischemia. CAD patients (94%) had segmental LVWM abnormalities at rest or with interruption of pacing; 3 patients with normal coronary arteries had abnormal angiographic LVWM (P < 0.01). Reduction in S1 spectral energy is a common accompaniment of myocardial ischemia. It was more frequently observed than abnormalities in either the ECG or LVEDP, but was not as consistently seen as segmental left ventricular wall motion abnormalities.

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