Erythroid Aplasia in Kwashiorkor

Abstract

demonstrated on a phonocardiogram when atrial systole occurs in the middle of ventricular systole in complete heart block.3 Under these circumstances the atrioventricular valves are closed and ventricular filling is obviously impossible. A presystolic gallop in an abnormal heart does not therefore, as stated in your annotation, result from the increased intensity of the low-pitched vibrations seen on a phonocardiogram of normal subjects, but is due to a different vibration which moves away from the first sound into a presystolic position.3-8 Finally, you have referred to the third heart sound gallop which " may be heard in heart failure, in mitral incompetence, or in constrictive pericarditis." Admittedly the diastolic sound in these instances may result from the same basic mechanism (in this respect the recent work of Nixon,9 who disputes the common belief that a third heart sound is produced by a vibration of the ventricular muscle, is noteworthy), but, since the sound associated with constrictive pericarditis usually occurs earlier and is higher pitched10 than a third heart sound gallop, should it not be regarded separately and be referred to as the early diastolic sound of constriction ?-I am, etc.,