Figure 200q

The external phonocardiogram and jugular venous pulse (JVP) tracing are recorded in a patient with severe pulmonary hypertension. The increased force of right atrial contraction is evident from the prominent "a" wave in the JVP. The S. is recorded in the fourth left intercostal space (4LICS) along the lower left sternal border. Note the increased amplitude of the S4 with inspiration.

IFrom JA Shaver Current uses of phonocardiography in clinical practice. In: E Rapaport (ed): Cardiology Update. New York, Elsevier, 1981, p 352.

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