Systolic ejection murmurs in the elderly: aortic valve and carotid arteries echo-Doppler findings.
Two-dimensional echographic and color Doppler studies of the heart and carotid arteries (CA) were performed in 45 patients greater than sixty-five years old without aortic stenosis, 23 with (Group 1) and 22 without (group 2) precordial ejection systolic murmur (SM). Aortic cusps thickening was found in 11 Group 1 (48%) and 2 Group 2 (9%) patients (p less than 0.001). Aortic root and aortic arch size were similar in the two groups. Maximum aortic flow velocity was significantly greater in Group 1 (200 60 cm/sec) than in Group 2 (120 20 cm/sec) (p less than 0.001). Left ventricular outflow systolic maximum velocity was similar in the two groups. A bilateral neck murmur was heard in 10/23 Group 1 patients (43%); in this group, patients with cervical SM had a greater maximum aortic flow velocity than those without cervical SM (230 + 60 cm/sec vs 172 + 32 cm/sec, p less than 0.001). In Group 1, 3 patients had a cervical SM louder on one neck side; only in these 3 patients were ipsilateral obstructive CA plaques found. A unilateral neck SM was heard in 4/22 Group 2 patients (18%); in these 4, ipsilateral obstructive CA were found.


CONCLUSIONS
(1) in the elderly, precordial ejection SM is related to mild increase in maximum aortic flow velocity and thickening of aortic cusps; (2) in patients with precordial SM radiated to both neck sides, maximum aortic flow velocity tends to be more markedly increased; (3) in patients with precordial SM, a cervical SM louder on one neck side should suggest coexistent ipsilateral CA stenosis.
Vigna
C
C
Division of Cardiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
Impagliatelli
M
M
Russo
A
A
Pacilli
M
M
De Rito
V
V
Perna
G P
GP
Villella
A
A
Langialonga
T
T
Fanelli
R
R
Rinelli
G
G
D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001783:Blood Flow Velocity / Q000502:physiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging*; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006337:Heart Murmurs / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D013599:Systole / Q000502:physiology