The Normal Heart Sounds in the Japanese:The Normal Phonocardiogram. I

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Using a multi-filter system phonocardiograph, 200 phonocardiograms of the normal Japanese were analysed, showing the ranges and the variations with age, and refering to some peculiar features in the Japanese. (1) Among 3 phases of both heart sounds, the 2nd phases had the longest duration in adolescence and became shorter particularly in the aged, corresponding to their snappy heart sounds. The 3rd phase of the 1st heart sound in the aged prolonged and/or increased by sclerotic process in the aorta. (2) The splitting of the 1st heart sound was rather physiologicalphenomenon and was found in 68% of cases, with an interval of 0.030 sec. on the average between 2 components. (3) The splitting of the 2nd heart sound was also physiologic, particularly in younger persons, and the over-all average interval between 2 components was 0.032 sec. The narrow splitting was also seen even during expiration in most cases with the splitting. (4) The Q-I interval was 0.050 sec. on the average and had a trend to increase with the age up to 20 years old. (5) The physiologic Hegglin's syndrome was sometimes seen in the normal subjects (1.5%). 6) The 1st heart sound was loudest at the apex in most cases, and the 2nd heart sound was commonly louder than the 1st heart sound even at this area (69% of total). Concerning the loudness of the 1st heart sound, both the absolute intensity estimated by the calibration method and the relative one determined by the comparison to the 2nd heart sound at the same area were so influenced by the P-R interval that the shorter this interval, the louder both intensities. This relationship was remarkable even in a comparison of the different subjects who had various intensities and P-R intervals. (7) Though the 2nd heart sound was usually loudest at the pulmonic area, it showed the maximal intensity at the lower sternal border or even at the apex, particularly in the older age group. The 2nd heart sound was rarely maximal in intensity at the aortic area, and in comparison of the basal 2nd heart sounds, the one at the pulmonic area was usually louder than that at the aortic area even in a half of the older groups. These findings may suggest that the aortic component of the 2nd heart sound, aside from the diminution of the absolute intensity in the aged, is well transmitted to the pulmonic area as well as downward to the apex.
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