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Br Heart J. 1989 February; 61(2): 144–148.
PMCID: PMC1216631

Relation of third and fourth heart sounds to blood velocity during left ventricular filling.

Abstract

To investigate the relation between changes in left ventricular inflow velocity and the timing of third and fourth heart sounds, simultaneous phonocardiograms and continuous wave Doppler traces were recorded in 48 patients (aged 17-78) with heart disease and in 21 normal children. The onset of the first vibration of the third heart sound coincided with peak left ventricular inflow blood velocity to within 5 ms in all but two of the patients. The mean (SD) difference between the two events was 5 (5) ms, which did not differ significantly from zero. The relation was similar in patients with primary myocardial disease (11), and in those with valve disease (26), hypertension (five), and coronary artery disease (four). In the normal children, the mean interval was 2.5 (5) ms--not significantly different from zero. By contrast, the first deflection of the fourth heart sound consistently preceded the timing of peak atrial inflow velocity by 55 (10) ms. Agreement was much closer between the onset of atrial flow and the onset of the atrial sound (mean difference 1 (5) ms, not significantly different from zero). Gallop sounds seem to be closely related to changes in ventricular inflow velocity, and thus to the effects of forces acting on blood flow. The forces underlying the third sound seem to arise within the ventricle and are responsible for sudden deceleration of flow during rapid ventricular filling. The fourth sound, occurring at the onset of the "a" wave, is more likely to arise from dissipation of forces causing acceleration of blood flow--that is, atrial systole itself.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Prewitt T, Gibson D, Brown D, Sutton G. The 'rapid filling wave' of the apex cardiogram. Its relation to echocardiographic and cineangiographic measurements of ventricular filling. Br Heart J. 1975 Dec;37(12):1256–1262. [PMC free article] [PubMed]
  • Porter CM, Baxley WA, Eddleman EE, Jr, Frimer M, Rackley CE. Left ventricular dimensions and dynamics of filling in patients with gallop heart sounds. Am J Med. 1971 Jun;50(6):721–727. [PubMed]
  • Ozawa Y, Smith D, Craige E. Origin of the third heart sound. I. Studies in dogs. Circulation. 1983 Feb;67(2):393–398. [PubMed]
  • Ishimitsu T, Smith D, Berko B, Craige E. Origin of the third heart sound: comparison of ventricular wall dynamics in hyperdynamic and hypodynamic types. J Am Coll Cardiol. 1985 Feb;5(2 Pt 1):268–272. [PubMed]
  • Ozawa Y, Smith D, Craige E. Origin of the third heart sound. II. Studies in human subjects. Circulation. 1983 Feb;67(2):399–404. [PubMed]
  • Marshall JC, Gibson DG. Origin of the Third Heart Sound. Br Med J. 1969 Sep 27;3(5673):b778–778. [PMC free article]
  • Gianelly RE, Popp RL, Hultgren HN. Heart sounds in patients with homograft replacement of the mitral valve. Circulation. 1970 Aug;42(2):309–321. [PubMed]
  • Van de Werf F, Minten J, Carmeliet P, De Geest H, Kesteloot H. The genesis of the third and fourth heart sounds. A pressure-flow study in dogs. J Clin Invest. 1984 May;73(5):1400–1407. [PMC free article] [PubMed]
  • Van de Werf F, Boel A, Geboers J, Minten J, Willems J, De Geest H, Kesteloot H. Diastolic properties of the left ventricle in normal adults and in patients with third heart sounds. Circulation. 1984 Jun;69(6):1070–1078. [PubMed]
  • WEITZMAN D. The mechanism and significance of the auricular sound. Br Heart J. 1955 Jan;17(1):70–78. [PMC free article] [PubMed]
  • Benchimol A, Desser KB. The fourth heart sound in patients without demonstrable heart disease. Am Heart J. 1977 Mar;93(3):298–301. [PubMed]
  • CREVASSE L, WHEAT MW, WILSON JR, LEEDS RF, TAYLOR WJ. The mechanism of the generation of the third and fourth heart sounds. Circulation. 1962 Apr;25:635–642. [PubMed]
  • Reddy PS. The third heart sound. Int J Cardiol. 1985 Mar;7(3):213–221. [PubMed]

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