Impulse Cardiogram in Early Diagnosis of Left Ventricular Dysfunction in Hypertension

An abnormal apical impulse has long been recog-nized in hypertensive cardiac disease. Beilin and Mounsey (1962) described in great detail the changes in the apical impulse occurring in a series of 25 hypertensive patients who had been brought into hospital with a view to treatment with hypotensive drugs. They showed that with the development of hypertensive cardiac disease, as demonstrated by the electrocardiogram and x-ray, there was an ab-normal prolongation of the apical impulse up to, or beyond, the second heart sound. They also stated that patients with borderline hypertrophy showed inconstant changes in the apical impulse while those without hypertrophy (as shown on the electrocardio-gram and chest x-ray) had an entirely normal impulse. The present paper is an extension of this work to determine the value of the apical impulse in deter-mining changes in left ventricular function at an earlier stage than indicated either by the electro-cardiogram or chest x-ray. SUBJECTS AND METHODS Studies were made on 47 patients (27 men and 20 women) with hypertension, whose ages ranged from 25 to 68 years, with an average of 51. Their height and weight were recorded and note was also made of their general physique. Four of them were acromegalic and another three had ischaemic heart disease as well. Their range of blood pressure was always measured at the time of recording the cardiac impulse. Careful clinical assessment of the position, amplitude, and form of the apical impulse was made. The apical impulse was then recorded with the impulse recorder, using a simultaneous phonocardiogram at the pulmonary area and an electro-cardiogram as reference tracings (Beilin and Mounsey