Figure 200t

Base and apex phonocardiograins are recorded with the ACG in a patient having complete heart block with AV dissociation. In the first and second complexes a prominent summation gallop (S3S4) is recorded due to atrial contraction occurring during the rapid filling phase of the left ventricle. In the third complex, atrial contraction occurs later, and only minimal vibrations are present at the time of the rapid filling wave of the ACG. In the first two complexes, the intensity of S1 is soft, while in the third complex in the setting of a short PR interval, there is marked increase in the mitral and tricuspid components of S1.

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