We studied mitral valve motion in 15 patients with aortic regurgitation and an Austin Flint murmur by recording simultaneously the phonocardiogram, apexcardiogram, and mitral valve echocardiogram. ...

On the Mechanism of the Austin Flint Murmur

Study of the mechanical events of the left ventricle by atraumatic techniques: Comparison of methods of measurement and their significance

For more than a century, eponymous signs of aortic regurgitation have occupied a prominent place in medical textbooks. The evidence that these signs are accurate indicators of aortic regurgitation ...

http://prdupl02.ynet.co.il/ForumFiles_2/18169304.pdf

Eponyms and the diagnosis of aortic regurgitation: what says the evidence?

Hemodynamic data from 45 patients with either aortic regurgitation (with and without the Austin Flint murmur) or aortic regurgitation and mitral stenosis were correlated with the a-wave percentage amplitude of the apexcardiogram. Changes in the a wave correlated well with corresponding changes in left heart pressures but not with variations in volume. Of 15 patients in whom the ratio of the a wave to the total excursion during systole (a/H ratio) was [See Equation in PDF file]13%, 11 had left ventricular end-diastolic pressures (LVEDP) >20 mm Hg. All patients with a/H ratios >15% had abnormal LVEDP. The converse was not true; 13 patients had elevated LVEDP with normal a/H ratios. Patients with aortic regurgitation and mitral stenosis had a/H ratios similar to those of normal subjects. The Flint murmur showed a significant correlation with left ventricular volume changes. Its presence was valuable in prediction of a large regurgitant volume and a high left ventricular stroke volume. It was also present in ...

The Austin Flint Murmur and the a Wave of the Apexcardiogram in Aortic Regurgitation

A general review and classification of additional diastolic and systolic sounds is presented. The mechanism of these sounds is discussed on the basis of new, partly unpublished, studies. 1. 1. The components of the third sound and of the atrial sound and their time relationship to intracardiac pressure changes are described. Recent studies have revealed a definite connection between the third sound and the end of active relaxation of the ventricular wall when distending forces act on the wall. The time relationship of the components of the atrial sound to intracardiac pressure changes are described, and the findings of intracardiac phonocardiograms in normal hearts are presented. 2. 2. The factors causing an increase of diastolic sounds (triple or quadruple rhythms) are discussed, and a general interpretation of these sounds is presented, relating the loud third sound to absolute or relative diastolic overload, and the loud atrial sound to absolute or relative systolic overload. 3. 3. The fact that in certain conditions a functional diastolic rumble occurs instead of a diastolic sound is stressed. 4. 4. The factors causing an opening snap of the mitral or tricuspid valve are reviewed and a general interpretation, partly based on data of intracardiac phonocardiography, is presented. Functional opening snaps can occur; the conditions of their occurrence (mostly increase of blood flow through an A-V valve) are discussed. 5. 5. The intervals between the aortic component of the second sound and the mitral or tricuspid sound or snap are described. The importance of these intervals lies in the fact that they can be related to the level of atrial pressure, thus permitting evaluation of the latter by a nontraumatic method. New data on the duration of this interval (isometric relaxation period or isovolumetric relaxation period) in normal subjects are presented. The differential diagnosis between split second sound and normal second sound followed by an opening snap or a third sound is presented. 6. 6. Friction rubs and their graphic recognition are described. 7. 7. Systolic sounds are described including the so-called “ejection sound” and the latesystolic click. Their clinical meaning is indicated.

Controversial and changing aspects of auscultation: III. Diastolic sounds IV. Intervals V. Systolic sounds

Electrocardiographic and Phonocardiographic Studies in Hypertension:Part II. Phonocardiographic Study with Special Reference to the Atrial Sound and "Q-1" Interval

Based on 15 autopsy cases including 13 of isolated aortic insufficiency and 2 of dissecting aortic aneurysm, the phonocardiogram of the Austin Flint murmur was analysed and the patho-anatomical determinant was investigated.The Austin Flint murmur was not infrequent in cases of severe aortic insufficiency, and the phonocardiogram as well as the auscultation revealed this murmur in all 15 cases. This murmur was composed of both mid-diastolic and presystolic (atrio-systolic) components of low-pitched vibration. The former was the essential component, which was following the third heart sound and had a decrescendo configuration. The latter showed little tendency of presystolic crescendo, and was not the essential component in some cases. The earlier appearance of the peak amplitude of the atrio-systolic component was illustrated and the importance of this graphic characteristic to differential diagnosis from organic mitral stenosis was suggested.Based on the patho-anatomy, the possibility of several assumptions advocated as to the cause of the Austin Flint murmur was discussed. In this respect, the importance of aortic regurgitant jet on the ventricular surface of the anterior leaflet of the mitral valve was stressed as a cause of this particular functional mitral stenosis.

/pdf/the-austin-flint-murmur-phonocardiographic-and-patho-33n8okfnzg.pdf

The Austin Flint murmur. Phonocardiographic and patho-anatomical study.

Phonoarteriographic study was carried on 41 cases of "aortitis syndrome". Despite the complexity of the arterial murmurs, stenotic arterial murmur is separable from non-stenotic (both accidental and pathological)arterial murmur based on the phonoarteriogram. Irrespective of the loudness, stenotic arterial murmur has crescendo-decrescendo configuration, i.e., early diamond in mild stenosis, mid-diamond in moderate stenosis and mid- to late diamond in severe stenosis. The last one is frequently transsystolic or even continuous. Moderate and severe stenosis are not easily separable on the routine phonoarteriogram, because the involvement of aorta and its branches varies from case to case and the configuration of the arterial murmur is influenced by the degree of involvement of the neighboring arteries and the degree of development of collateral vessels. However, the functional phonoarteriography using amyl nitrite or methoxamine has a value in the quantitative assessment of the degree of stenosis. With amyl nitrite inhalation, the arterial murmur of moderate stenosis increases as in the cases of mild stenosis, whereas the one of severe stenosis decreases and so it does the continuous murmur. Methoxamine has an opposite effect on the arterial murmur. Collateral vessels give no significant murmur except a few cases of kinking with marked angulation of artery, and it is late diamond with delayed onset. It is concluded that the routine as well as functional phonoarteriography has an important diagnostic value in the assessment of the obstructive arterial disease and warrants the use before a patient is submitted to more complicated diagnostic procedures such as aortography or arteriography.

Quantitative assessment of obstruction of the aorta and its branches in "aortitis syndrome". The value of functional phonoarteriography using vasoactive drugs.

The Pwave in hypertension was studied comparing with that in normal and mitral stenosis.(1) In various findings of the Pwave, there were significant differences between normal and pathological conditions. Hypertensive cases had inter-mediate changes compared with the other two groups, and these changes were intensified by the elevation in the diastolic blood pressure level.(2) From the results obtained in these comparison studies, we proposed the 7 electrocardiographic criteria to assess the changes in the Pwave in both hypertensive and mitral stenosis. In hypertensive cases, the incidence of each criterion was increased according to the elevation in the diastolic blood pressure level. Special attention was given to some criteria, namely "relative" left axis deviation of the Pwave, which was characteristic to mitral stenosis and mild hypertension, and the finding that the amplitude of the Pwave in lead V6 was higher than that in V5, which indicated the more definite sign of the left atrial overloading and often seen in mitral stenosis and severe hypertension.(3) The grade of Pwave change gave us the more distinctive differentia-tion of the Pwave between normal and mitral stenosis. In hypertension, this grade was increased with the elevation in the diastolic blood pressure level, and in severe cases, the grade of Pwave change became similar to that seen in mitral stenosis.(4) On the bases of the observations in the follow-up cases as well as above-mentioned results, we suggested that the change in the Pwave in hypertension was a reflection of the left atrial overloading possibly resulted from the left ventricular one.

https://www.jstage.jst.go.jp/article/ihj1960/1/2/1_2_213/_pdf

Electrocardiographic and Phonocardiographic Studies in Hypertension

Patho-anatomical study was carried on 5 cases with "silent" mitral stenosis to search any responsible factors for a disappearance of pathognomonic apical diastolic rumble.Compared with 15 control cases with mitral stenosis, the following pathoanatomical determinants were thought to be responsible.(1) Marked restriction of mitral valve movement, especially of mobile "trigone" of anterior leaflet.(2) Adhesion, thickening and shortening of chordae tendineae causing the formation of the second point of stenosis below the valve.(3) Postero-medially deviated mitral valve orifice.(4) Left atrial huge thrombi.(5) Combination of these factors.The meaning of these patho-anatomical factors was discussed.

"silent" mitral stenosis. patho-anatomical basis of the absence of diastolic rumble.

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