Luisada A A, Frazin L, Singhal A, Nunez A
Jpn Heart J. 1985 Jan;26(1):133-43. doi: 10.1536/ihj.26.133.
Four clinical cases of subaortic hypertrophic muscular stenosis are discussed. All four, in addition to a loud systolic murmur, had a loud systolic click. However, the timing of the click and its relationship to the phase of the carotid pulse were different in each case varying from close to medium and to distant (or midsystolic). The comparison of the sound tracing with the carotid tracing demonstrated that, in each case, a sudden change in acceleration was taking place. In one, the click coincided with the onset of the carotid upstroke; in another, with the first peak of the carotid pulse; in the third, with the trough between first and second peak of the pulse; in the last, with a sudden drop of the pulse at mid-systole caused by sudden obstruction to flow. It is concluded that the clicks were caused by rapid changes of acceleration resulting from the abnormal aortic ejection. Thus, the study of the carotid pulse and of the sound tracing are important for a non-invasive diagnosis together with the echo study of the septum and ventricular wall.
本文讨论了4例主动脉瓣下肥厚性肌性狭窄的临床病例。所有4例除了有响亮的收缩期杂音外，均有响亮的收缩期喀喇音。然而，每例喀喇音出现的时间及其与颈动脉搏动时相的关系各不相同，从接近中期到较远（或收缩中期）不等。将心音图与颈动脉搏动图进行比较显示，每例均出现了加速度的突然变化。在1例中，喀喇音与颈动脉上升支的起始点同时出现；在另1例中，与颈动脉搏动的第一个峰值同时出现；在第3例中，与搏动的第一个和第二个峰值之间的波谷同时出现；在最后1例中，与由于血流突然受阻导致的收缩中期脉搏突然下降同时出现。得出的结论是，喀喇音是由异常主动脉射血导致的加速度快速变化引起的。因此，颈动脉搏动和心音图的研究对于与室间隔和心室壁的超声研究一起进行无创诊断很重要。
