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The atrial presystolic murmur, once thought specific for atrial septal defects, is actually common in various conditions, including normal subjects. This phonocardiographic finding is not a reliable indicator of atrial septal defects.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- The crescendo-decrescendo pattern of atrial presystolic murmur is traditionally considered a hallmark of atrial septal defect (ASD).
- Previous understanding suggested high specificity for this murmur in diagnosing ASD.
Purpose of the Study:
- To investigate the actual occurrence and diagnostic specificity of atrial presystolic murmur.
- To determine the range of clinical conditions associated with atrial presystolic murmur.
Main Methods:
- A retrospective analysis of 460 consecutive cases was conducted.
- The presence and characteristics of atrial presystolic murmurs were recorded and correlated with patient diagnoses.
Main Results:
- Atrial presystolic murmur was identified in 67 out of 460 cases (approximately 14.6%).
- Of these, only 6 cases were diagnosed with atrial septal defect, and 4 with mitral valvular diseases.
- The murmur was observed across a wide spectrum of clinical entities and in normal subjects.
Conclusions:
- Atrial presystolic murmur is not a specific phonocardiographic finding for atrial septal defect.
- The murmur occurs in diverse clinical situations and can be present in individuals without cardiac abnormalities.
- Multiple factors likely contribute to the generation of atrial presystolic murmur, necessitating a broader diagnostic approach.
Abstract:
A crescendo-decrescendo pattern of atrial presystolic murmur has long been considered highly specific for atrial septal defect. Atrial presystolic murmur was observed in 67 or 460 consecutive cases. Of these 67 cases, there were only six with atrial septal defect and four with mitral valvular diseases. The occurrence of atrial presystolic murmur was observed over a broad spectrum of clinical entities. Although the precise pathogeneis of atrial presystolic murmur is not clearly defined, certain conclusions can be drawn from the present study, as follows: (1) atrial presystolic murmur is observed in a variety of clinical situations; (2) atrial presystolic murmur is not infrequently observed in normal subjects; (3) atrial presystolic murmur is not a specific phonocardiographic finding for atrial septal defect; and (4) atrial presystolic murmur may be caused by a multiplicity of factors.