PHARMACOLOGICAL METHODS IN THE PHONOCARDIOGRAPHIC DIAGNOSIS OF REGURGITANT MURMURS

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Abstract
In 64 patients nor-epinephrine, amylnit-rite, serotonin and methoxamine were employed to change the intensity of regurgitant murmurs. It was found that nor-epinephrine and methoxamine by raising pressure in the systemic circulation increased murmurs caused by incompetence of left heart valves. They increase, therefore, mitral systolic and aortic diastolic murmurs. Serotonin, by raising pulmonary artery pressure, increased regurgitation at the tricuspid and pulmonary valves and thereby also the amplitude of the tricuspid systolic and pulmonary diastolic murmurs. Amylnitrite reduced regurgitant murmurs from the left heart and increased regurgitant murmurs from the right heart, provided these were associated with mitral stenosis. Since nor-epinephrine increased vascular resistance in both the systemic and pulmonary circulations, it could not be used to differentiate right and left sided regurgitant murmurs. Serotonin and methoxamine were found to be suitable for this purpose since these drugs exert an isolated effect on the pulmonary and systemic circulations respectively. Amylnitrite, under certain conditions, also served this purpose by increasing regurgitant murmurs of the right and reducing regurgitant murmurs of the left heart.