On certain abnormal ballistic complexes; their relationships to other mechanical and electrical events of the cardiac cycle.

Ballistocardiograms were recorded simultaneously with intra-atrial and intra-aortic pressure curves, heart sounds, electrokymograms and electrocardiograms in patients with various types of heart disease. In several of these subjects, in addition to the usual ballistic waves, abnormal sets of ballistic complexes occurred. In some individuals, one or more of these abnormal ballistic complexes was so prominent that it dominated the entire ballistocardiogram. By correlating the abnormal ballistic waves with other dynamic and electrical events, we have secured information which throws light on the genesis of certain abnormal waves and of the so-called H wave in the ballistocardiogram. B ALLISTOCARDIOGRAMS of individuals with heart disease may show a wide variety of abnormalities. Starr, Hamilton, Nickerson, Brown, and others have described many abnormal ballistic patterns associated with various clinical entities.'-" The purpose of this study has been to establish a physiologic basis for some of these abnormal waves, by recording ballistic and other circulatory phenomena simultaneously. MATERIAL AND METHOD OF STUDY Recording Methods and Equipment. The ballisto-cardiographs used in this investigation were the original electromagnetic and the modified photo-electric (Sanborn) types developed by Dock and Taubman."1 Through the courtesy of Dr. Isaac Starr, we were also able to obtain one to three trac-ings by the table ballistocardiograph' in each of our patients for comparative study. Ballistocardiograms taken with these three sets of instruments were found to check accurately in form and timing. Catheteriza-tions of the right atrium and aorta were done by the small plastic catheter technic utilizing a Lilly capacitance manometer as described 74 Schnabel, and Peterson.'6 The time lag of this arrangement was about 0.002 second. The electroky-mographic equipment was of the type developed by Henny, Boone, and others,'7 18 and manufactured by the Cambridge Instrument Company. The time lag of this instrument has been calibrated at 0.015 second with a frequency range of 1 to 35 cycles per second. The apex impulse was recorded by means of a glycerine capsule. The deflections were amplified through a Lilly capacitance manometer. The phono-graphic, lead II electrocardiographic, and other recordings were all taken on a Sanborn tribeam instrument with film speeds of 25 mm. and 75 mm. per second. Technically, it was impossible to record all the hemodynamic phenomena simultaneously, and as a result, multiple recordings in various combinations of three were taken simultaneously with the phono-cardiograph and/or the electrocardiograph. In order to avoid unnecessary repetition and confusion in presentation of the data, …