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Incidence of murmurs in the aging heart
Insights
In elderly patients without organic heart disease, a basal systolic murmur often indicates an aortic flow murmur. This murmur may result from aortic dilation or minor aortic valve commissure fusion.
Area of Science:
- Cardiology
- Geriatric Medicine
- Diagnostic Cardiology
Background:
- Systolic murmurs in the elderly can be challenging to diagnose.
- Distinguishing benign murmurs from pathological ones is crucial for appropriate patient management.
Purpose of the Study:
- To investigate the cause of basal systolic murmurs in elderly patients without pre-existing heart conditions.
- To determine the association between basal systolic murmurs and aortic abnormalities in this demographic.
Main Methods:
- Clinical assessment of 100 patients aged 60+ excluding those with cardiac enlargement, valvular lesions, or ECG-left ventricular hypertrophy.
- Phonocardiograms (PCGs), mitral echograms, pulse tracings, ECGs, and chest roentgenograms were performed on 28 patients with systolic murmurs.
- Analysis of murmur characteristics, valve function, and aortic dimensions.
Main Results:
- A significant systolic murmur was detected in 30% of the studied elderly population.
- Eighty-three percent of patients with basal systolic murmurs showed aortic enlargement on chest roentgenograms.
- Mitral valve echograms and pulse tracings were normal, ruling out mitral valve disease or significant hemodynamic compromise.
Conclusions:
- Basal systolic murmurs in the elderly without organic heart disease are likely related to aortic flow phenomena.
- Aortic dilatation or minor aortic valve commissure fusion are probable causes.
- This finding aids in the non-invasive diagnosis and management of cardiac murmurs in older adults.
Abstract:
One hundred patients aged 60 or older were studied clinically after excluding those with cardiac enlargement, definite valvular lesions or electrocardiographic (ECG) evidence of left ventricular hypertrophy. In 30 of the the 100 patients a significant systolic murmur was heard on auscultation. Phonocardiograms (PCGs), mitral echograms and pulse tracings were obtained in 28 of these 30 patients (2 had died meanwhile), and the ECGs and chest roentgenograms were reviewed. In 23 PCG patients there was an early or midsystolic murmur, best recorded at the base of the heart and often transmiteed to the apex. Mitral valve echograms and carotid and jugular pulse tracings were normal in all cases. Chest roentgenograms revealed aortic enlargement in 83 percent of the 23 patients. In the elderly with no evidence of organic heart disease, a basal systolic murmur is probably an aortic flow phenomenon caused by either moderate aortic dilatation or minimal fibrotic fusion of one or more commissures of the aortic valve.