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Systolic ejection murmurs in the era of modern cardiology

What do we really know?

^a Heart and Vascular Institute of Texas, San Antonio, Texas, USA

View larger version (21K): [in a new window]   Figure 1 Simultaneous left ventricular (LV) pressure signals obtained by Millar micromanometers in the LV cavity and the LVOT. Also shown is LVOT outflow velocity and an electronically derived LV pressure difference signal. Dotted arrows point to the timing of peak LV-LVOT pressure-gradient development. Solid arrows point to the timing of peak LV outflow velocity. See text for discussion.

View larger version (27K): [in a new window]   Figure 2 Simultaneous LV and aortic pressure signals obtained by Millar micromanometers in the LV and proximal aorta, just above the aortic valve during rest, exercise and isoproterenol infusion. Also shown is aortic flow velocity and an electronically derived LV-AO "impulse gradient" (IG) signal. Arrow definitions as in Figure 1. See text for discussion.

View larger version (24K): [in a new window]   Figure 3 Post-PVC dynamics in a subject with normal LV and aortic valve function using the same techniques as in Figure 2. See text for discussion.

View larger version (27K): [in a new window]   Figure 4 Single cardiac cycle from a patient with critical aortic stenosis. See text for discussion.

View larger version (34K): [in a new window]   Figure 5 Hypertrophic cardiomyopathy. Complex multisite sources for composite externally detected systolic murmur. SSC = SAM septal contact; LA = left atrium; other abbreviations as previously defined. See text for discussion.