A systolic murmur is a common presentation of aortic regurgitation detected by echocardiography.
BACKGROUND
The finding of aortic regurgitation at a classical examination is a diastolic murmur.


OBJECTIVE
Aortic regurgitation is more likely to be associated with a systolic than with a diastolic murmur during routine screening by a noncardiologist physician.


METHODS
In all, 243 asymptomatic patients (mean age 42 +/- 10 years) with no known cardiac disease but at risk for aortic valve disease due to prior mediastinal irradiation (> or = 35 Gy) underwent auscultation by a noncardiologist followed by echocardiography. A systolic murmur was considered benign if it was grade < or = II/VI, not holosystolic, was not heard at the apex, did not radiate to the carotids, and was not associated with a diastolic murmur.


RESULTS
Of the patients included, 122 (49%) were male, and 86 (35%) had aortic regurgitation, which was trace in 20 (8%), mild in 52 (21%), and moderate in 14 (6%). A systolic murmur was common in patients with aortic regurgitation, occurring in 12 (86%) with moderate, 26 (50%) with mild, 6 (30%) with trace, and 27 (17%) with no aortic regurgitation (p < 0.0001). The systolic murmurs were classified as benign in 21 (78%) patients with mild and 8 (67%) with moderate aortic regurgitation. Diastolic murmurs were rare, occurring in two (14%) with moderate, two (4%) with mild, and three (2%) with no aortic regurgitation (p=0.15).


CONCLUSIONS
An isolated systolic murmur is a common auscultatory finding by a noncardiologist in patients with moderate or milder aortic regurgitation. A systolic murmur in patients at risk for aortic valve disease should prompt a more thorough physical examination for aortic regurgitation.
VA Palo Alto Health Care System, California 94304, USA. heiden@stanford.edu
Paul A
PA
Heidenreich
Ingela
I
Schnittger
Steven L
SL
Hancock
J Edwin
JE
Atwood
D000328:Adult; D000367:Age Factors; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D004452:Echocardiography; D005260:Female; D006326:Heart Auscultation; D006337:Heart Murmurs / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D012680:Sensitivity and Specificity; D013599:Systole; D014421:Turkey / Q000453:epidemiology