THE USE OF INDIRECT ARTERIAL PULSE TRACINGS IN THE DIAGNOSIS OF CONGENITAL HEART DISEASE

Abstract

Studies were made of the carotid arterial pulse curves, recorded by indirect means utilizing a crystal microphone system, of 21 normal patients and 38 patients fulfilling the clinical criteria of congenital aortic or subaortic stenosis, 6 of whom had coexisting coarctation of the aorta.

There were definite and constant abnormalties in the pulse curves of the carotid artery in the group with aortic or subaortic stenosis. These were characterized by the presence of an initial sharp anacrotic notch placed low on the ascending limb of the Pulse curve; a series of systolic vibrations on the ascending limb, the graphic representation of a palpable thrill in the carotid vessels of these patients; plateau formation near the peak of the curve; a slow rise of the ascending limb of the curve to reach a later peak than normally seen; and, in some cases, an increased duration of systole as measured from the beginning of the carotid upstroke to the dicrotic notch of the carotid.

Although the patients studied would appear to fulfill the clinical criteria for diagnosis of congenital subaortic stenosis as opposed to congenital aortic valvular stenosis, it is emphasized that the differential diagnosis of these 2 conditions may not be possible during the life of the patient.

It is stressed that congenital aortic or subaortic stenosis may be considerably more frequent than can be judged by previously reported necropsy statistics and that, in addition, there may be a frequent association of these conditions with coarctation of the aorta.