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Systolic Ejection Murmurs in the Elderly: Aortic Valve and Carotid Arteries Echo-Doppler Findings

Division of Cardiology and the Section of Angiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo

Matteo Impagliatelli

Division of Cardiology and the Section of Angiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo

Aldo Russo

Division of Cardiology and the Section of Angiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo

Michele Pacilli

Division of Cardiology and the Section of Angiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo

Vincenzo De Rito

Division of Cardiology and the Section of Angiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo

Gian Piero Perna

Division of Cardiology and the Section of Angiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo

Alessandro Villella

Division of Cardiology and the Section of Angiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo

Tommaso Langialonga

Division of Cardiology and the Section of Angiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo

Raffaele Fanelli

Division of Cardiology and the Section of Angiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo

Gabriele Rinelli

Department of Cardiology, Catholic University "Sacro Cuore", Rome, Italy

Antonella Lombardo

Department of Cardiology, Catholic University "Sacro Cuore", Rome, Italy

Francesco Loperfido

Department of Cardiology, Catholic University "Sacro Cuore", Rome, Italy

Two-dimensional echographic and color Doppler studies of the heart and carotid arteries (CA) were performed in 45 patients > 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 < 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 < 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 < 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.

Angiology, Vol. 42, No. 6, 455-461 (1991)
DOI: 10.1177/000331979104200604


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