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Titolo:
Echocardiography in the evaluation of systolic murmurs of unknown cause
Autore:
Jost, CHA; Turina, J; Mayer, K; Seifert, B; Amann, FW; Buechi, M; Facchini, M; Brunner-La Rocca, HP; Jenni, R;
Indirizzi:
Univ Zurich Hosp, Div Cardiol, CH-8091 Zurich, Switzerland Univ Zurich Hosp Zurich Switzerland CH-8091 CH-8091 Zurich, Switzerland Univ Zurich, Dept Biostat ISPM, Zurich, Switzerland Univ Zurich Zurich Switzerland , Dept Biostat ISPM, Zurich, Switzerland
Titolo Testata:
AMERICAN JOURNAL OF MEDICINE
fascicolo: 8, volume: 108, anno: 2000,
pagine: 614 - 620
SICI:
0002-9343(20000601)108:8<614:EITEOS>2.0.ZU;2-3
Fonte:
ISI
Lingua:
ENG
Soggetto:
VALVULAR AORTIC-STENOSIS; EJECTION MURMURS; DOPPLER-ECHOCARDIOGRAPHY; REGURGITATION; SEVERITY; DISEASE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
34
Recensione:
Indirizzi per estratti:
Indirizzo: Jost, CHA Univ Zurich Hosp, Div Cardiol, Ramistr 100, CH-8091 Zurich, Switzerland Univ Zurich Hosp Ramistr 100 Zurich Switzerland CH-8091 zerland
Citazione:
C.H.A. Jost et al., "Echocardiography in the evaluation of systolic murmurs of unknown cause", AM J MED, 108(8), 2000, pp. 614-620

Abstract

PURPOSE: Systolic murmurs are common, and it is important to know whether physical examination can reliably determine their cause. Therefore, we prospectively assessed the diagnostic accuracy of a cardiac examination in patients without previous echocardiography who were referred for evaluation of a systolic murmur. SUBJECTS AND METHODS: In 100 consecutive adults (mean [+/- SD] age of 58 +/- 22 years) who were referred for a systolic murmur of unknown cause, the diagnostic accuracy of the cardiac examination by cardiologists (without provision of clinical history, electrocardiogram, or chest radiograph) was compared with the results of echocardiography. RESULTS: The echocardiographic findings included a normal examination (functional murmur) in 21 patients, aortic stenosis in 29 patients, mitral regurgitation in 30 patients,left or right intraventricular pressure gradient in 11 patients, mitral valve prolapse in 11 patients, ventricular septal defect in 4 patients, hypertrophic obstructive cardiomyopathy in 3 patients, and associated aortic regurgitation in 28 patients. In 28 (35%) of the 79 patients with organic heart disease, more than one abnormality was found; combined aortic and mitral valve disease was the most frequent combination (n = 22). The sensitivity of the cardiac examination was acceptable for detecting ventricular septal defect (100% [4 of 4]), isolated mitral regurgitation (88% [26 of 36]), aortic stenosis (71% [21 of 29]), and a functional murmur (67% [14 of 21]),but not for intraventricular pressure gradients (18% [2of 11]), aortic regurgitation (21% [6 of 28]), combined aortic and mitral valve disease (55% [6 of 11]), and mitral valve prolapse (55% [12 of 22]). In 6 patients, the degree of aortic stenosis was misjudged on the clinical examination, mainly because of a severely diminished left ventricular ejection fraction. Significant heart disease was missed completely in only 2 patients. CONCLUSION: In adults with a systolic murmur of unknown cause, a functional murmur can usually be distinguished from an organic murmur. However, the ability of the cardiac examination to assess the exact cause of the murmur is limited, especially if more than one lesion is present. Thus, echocardiography should be performed in patients with systolic murmurs of unknown cause who are suspected of having significant heart disease. (C) 2000 by Excerpta Medica, Inc.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/03/20 alle ore 09:10:02