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Alternative Chiropractic

Excerpted from Chapter 9, Phonocardiography

For years the electrocardiograph has been the premier diagnostic instrument in the field of cardiology.In most doctor’s offices, the procedure is to take a case history and if that, along with auscultation with a stethoscope, reveals anomlies, run an ECG for verification. This is a common sense pratice. Several chiropractic physicians have specialized in cardiac problems and the interpretation of ECG tapes with a marked degree of success.

Unfortunately, until recently phonocardiography was often treated in a rather casual manner for reasons that are sometimes obscure. It seems reasonable to assume that a visual transcription of the sounds that we hear with a stethoscope would help in arriving at a more complete diagnostic assumption regarding the condition of the patient’s heart.

In school only a cursory introduction to phonocardiography was given. It wasn’t until I was in practice and aware of the need for proper auscultation that I began to experiment with different devices for hearing better. Because of a slight hearing loss in one ear, the finer sounds were lost and I felt I was fooling my patients when I would put down my stethoscope and tell them everything was fine. I really didn’t know for sure. The purchase of an electronic stethoscope helped, but I still wasn’t getting the sounds I wanted and my ECG, of course, registered only the electrical depolarization of the myocardium. I thought I must remain satisfied with what I had.

One day, while I was perusing some old publications I had in my files, I came across some manuals to be used with a phonocardiographic unit called an Endocardiograph. They had been given to me while I was in school and were promptly forgotten. Eagerly I read them. This was what I had been looking for and it had been at my fingertips all the time.

Knowing what you need and getting it are two completely different things. Most of the portable phonocardiographic units around at present are quite old and not often used. I finally ran one down at a colleague’s office and purchased it so I could integrate it as soon as possible into my physical examination procedures. Since that time, I have found that it has become an almost indispensable tool when giving a comprehensive cardiac examination.

The heart is an incredibly interesting organ. From its embryonic state as a vascular dilation, it becomes an indispensable four-chambered structure with muscle that is indigenous only to, and for, its own use. It also has its own “electrical” system found in no other organ. As intricate as the heart may seem, its concept is an exercise in simplicity and pragmatism. The right side chambers receive the used blood from the body in the upper chamber and the lower one expels it to the lungs to exchange carbon dioxide for the oxygen. The left side of the heart receives the blood that now has a fresh supply of oxygen from the lungs into the upper chamber and expels this blood through the aorta to the entire body, even its own myocardium, from the lower. The upper chambers receive; the lower expel. To complete this grand circuit, the blood has to pass through four valves that react to the pressure flow of the blood being pumped. When ventricular systole begins, the mitral and tricuspid valves guarding the atria close, and the blood is pumped from the right ventricle through the pulmonary artery and into the lungs, and from the left ventricle through the aorta and into systemic circulation.

Neural innervation is derived from three primary sources. Within the heart, in the right atrium, are the sinoatrial node and the atrioventricular node. An impulse traveling from the SA to the AV node proceeds to the bundle of His, and from there to the right and left bundle branches and the Purkinje fibers to form the contractive phase of the heart. Exogenous neural stimulation comes from the parasympathetics primarily via the left branches of the vagus nerves, which aid in the formation of the cardiac plexus, and from the sympathetics via the first through the fourth or fifth thoracic segments.

All of the preceding, of course, only touches on the most basic fundamentals of cardiac anatomy and physiology that we learned in school. It’s wise, however, to review what we have learned in the past to better apply what we might learn in the future.

In cardiac auscultation, we are listening for the rhythm of the heart and for the integrity of its four valves. Few instruments are better suited for recording the sounds of the heart than the phonocardiographic instrument known as the Endocardiograph. It’s light, portable and, when properly applied, accurate and relatively diagnostic.

While phonocardiography is an extension of normal cardiac auscultation, it should be treated as a special procedure. This is necessary because of the many factors that can affect any kind of sensitive instrumentation. It’s important that the patient have a period of at least fifteen minutes of relaxation before taking the phonocardiograph. This is especially necessary if the patient is hypertense, since stress conditions will often have a marked effect upon the rhythmic patterns of the heart.

With the patient in a forty-five-degree reclining position, the microphone is placed on the four auscultatory points for individual readings. While these points are the customary areas for best auscultation, it’s wise to listen and move the microphone around until the maximum intensity is heard. In those individuals in which the sound is too soft for a good recording, the patient can be placed in an erect position or leaned slightly forward to bring the heart closer to the chest wall and, therefore, improve the quality of the sound. While the phonocardiographic tracings can be taken through clothing, I believe it is best to maintain a consistency of quality by placing the microphone directly on the integument. If the patient has a hairy chest, it should be matted down with moisture so that the interference from possible friction won’t be recorded. Remember, this is a sensitive instrument that requires care if recordings of any diagnostic value are to be obtained.

When everything is properly prepared, have the patient take a deep breath and then exhale. This brings the heart closer to the chest wall and cuts down possible interference. The patient must be cautioned to be perfectly still while the graph is being made, and it is wise to make sure that the tracings are run at least two hours after the patient has had a meal to reduce the possibility of recording digestive sounds.

The results of a phonocardiographic recording that has been properly prepared and well produced can be quite satisfying. With a measure of concentration and study, sound patterns of anomalous conditions can be readily observed.

Unfortunately, too many chiropractic physicians panic when a cardiac pathology is observed; this is wrong. Often, the treatment of choice can and should be conservative. I’ve seen cardiac patients drugged almost senseless by some allopaths who indiscriminately treat symptoms rather than the cause. I know of no better way to obtain consistently satisfying results with cardiac arrhythmias than by the application of specific adjustive procedures in the cervical and upper thoracic spine. Valvular problems have been treated satisfactorily with herbal combinations containing hawthorn berries, motherwort and lily of the valley. Specific nutritional aids to general cardiac welfare have been pioneered by nutritionists in the chiropractic profession.

That thoracic pain or pain in the arm could mean more than a subluxation. It could be the precursor to a severe cardiac problem. It is incumbent upon us to recognize this possibility and refer or treat it. This by no means should result in endangering the health or safety of your patient. Consultation with those using more radical and more comprehensive diagnostic instrumentation should be sought and therapeutic cooperation encouraged. While the diagnostic value of in-office phonocardiography with portable instruments has been found debatable by leading cardiologists, I believe that when its findings are correlated with those drawn from other viable sources, they take on a more complete and important dimension. Whatever you do, the most important thing is that you find out what to do.

Unfortunately the FDA closed down the manufacture of the Endocardiograph in 1963 to “save” the public from any claims that the instrument might be able to act as a guide to nutritional therapeutics for the heart. They are still around—old maybe—but can be found.

Fortunately the battle with the FDA was joined by those in the field who believed in the value of nutrition and phonocardiography. After years of research and experimentation a new and even more sophisticated phonocardiograph was developed. Thanks to the efforts of three chiropractors, Drs. Walter Schmitt, Richard Murray and George Goodheart, we now have access to the Acoustic Cardiograph (ACG). The ACG is more compact, dimensional and accurate than its older cousin and can be easily purchased from the International Foundation for Nutrition and Health in San Diego, California.

No office based on a solid diagnostic paradigm should be without some form of phonogardiography.

This text is followed by photos and actual phono- and endo-cardiographic charts.

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