Auscultatory Findings in Pericardial Effusion and in Ventricular Aneurysm

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Abstract
A useful sign in selected cases of pericardial effusion has been the effect of position on intensity of heart sounds. In normals, the sounds remain the same or become louder when the subject turns from his back onto his stomach. In some cases of pericardial effusion, heart sounds and murmurs become fainter. It is postulated that with more moderate amounts of effusion, coincident with change in patient''s position from flat (back) to the abdomen, more fluid is interposed between the heart and the stethoscope, thereby decreasing the sounds and murmurs. With minimal or massive effusions, little change may occur. A false positive sign may be elicited in the presence of pleural fluid. A systolic sound at the apex is heard in some patients with a ventricular aneurysm. The systolic sound coincides with a prominent systolic impulse readily palpable in a localized spot at the apex. The sound is most likely produced by the paradoxical systolic bulge (or expansion) of the localized aneurysmal area striking against the chest wall. As to whether this systolic sound will be present or not, will depend naturally upon the location of the aneurysm and the extent of involvement.

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