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[Functional aortic systolic murmurs in the elderly]
Insights
Functional systolic murmurs in elderly patients are often caused by aortic valve calcification or aortic dilatation, not aortic stenosis. These "innocent" murmurs can be distinguished from pathological murmurs by specific clinical and phonocardiographic features.
Area of Science:
- Cardiology
- Geriatrics
- Pathology
Context:
- Elderly patients often present with systolic murmurs.
- Distinguishing functional murmurs from pathological aortic stenosis is clinically important.
- Previous terminology like "mitro-aortic murmur" may be misleading.
Purpose:
- To clinically and phonocardiographically characterize functional aortic systolic murmurs in the elderly.
- To differentiate these murmurs from true aortic stenosis.
- To identify the underlying causes of these functional murmurs.
Summary:
- Functional aortic systolic murmurs in 26 elderly patients were studied.
- Key differentiating features include absence of thrill, murmur characteristics, aortic sound changes, and normal arteriogram.
- Pathological confirmation in 19 patients revealed aortic valve calcification and/or ascending aorta dilatation without stenosis.
Impact:
- Provides criteria to differentiate innocent systolic murmurs from aortic stenosis in the elderly.
- Suggests that "innocent" murmurs result from age-related changes like calcification or dilatation.
- Recommends discontinuing the term "mitro-aortic murmur".
Abstract:
The authors report a clinical and phonocardiographic study of functional aortic systolic murmurs in 26 elderly patients, in 19 of which the lesion was confirmed pathologically. Systolic murmurs radiating across the chest in elderly have the same clinical characteristics as aortic stenosis from which they may, however, be distinguished owing to the: absence of a thrill during systole. The brief duration and the proto-meso-systolic position of the murmur with early inscription of maximal oscillations on the phonocardiogram. Conversion of the second aortic sound. Almost constant absence of a diastolic murmur. Normal carotid arteriogram, including normal ejection time after correction and time of half rise. "Innocent" systolic murmurs are due to calcification of the aortic valve without stenosis, and/or dilatation of the ascending aorta. There is no systolic pressure gradient between the left ventricle and the aorta during cardiac catheterisation. No lesions were found in the mitral valve suggesting mitral incompetence, therefore, we consider the term mitro-aortic murmur used by Huchard should be dropped; Radiation of the murmur from the apex of the heart up into the neck may be explained by the simultaneous occurrence of anatomical changes due to age and/or hypertension and by the vibratory nature of the murmurs which become propagated above and below their origin, as shown by the intracardiac recordings.