Perception of binary acoustic events associated with the first heart sound

The resolving power of the auditory apparatus permits discrete vibrations associated with cardiac activity to be perceived as one or more events. Irrespective of the vibratory combinations recorded by conventional phonocardiography, in normal adults and in most adult patients auscultators tend to discriminate only two discrete events associated with the first heart sound S1. It is stressed that the heart sound S4 may be present when a binary acoustic event associated with S1 occurs in the sequence 'low pitched sound preceding high pitched sound', i.e., its components are perceived by auscultation as 'dull-sharp'. The question of S4 audibility arises in those individuals, normal and diseased, in whom the major components of S1 ought to be, at least clinically, at their customary high pitch and indeed on the PCG appear as high frequency oscillations. It is revealed that the apparent audibility of recorded S4 is not related to P-R interval, P-S4 interval, or relative amplitude of S4. The significant S4-LFC (low frequency component of S1) differences can be related to acoustic modification of the early component of S1.