BASAL SYSTOLIC MURMURS AND THE CAROTID PULSE CURVE IN THE DIAGNOSIS OF CALCAREOUS AORTIC STENOSIS

Abstract

Article1 February 1959BASAL SYSTOLIC MURMURS AND THE CAROTID PULSE CURVE IN THE DIAGNOSIS OF CALCAREOUS AORTIC STENOSISGEORGES DAOUD, M.D., EDMUND H. REPPERT JR., M.D., J. SCOTT BUTTERWORTH, M.D., F.A.C.P.GEORGES DAOUD, M.D., EDMUND H. REPPERT JR., M.D., J. SCOTT BUTTERWORTH, M.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-50-2-323 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptWe have reviewed the last 30 autopsies at the University Hospital in which the diagnosis of calcareous aortic stenosis was made by the pathologist. Somewhat to our surprise we found that the clinical diagnosis had been missed in 65% of the cases, although we should have expected this from the literature1, 2, 3 and our own studies.The literature reveals many opinions concerning calcareous aortic stenosis. For instance, the etiology has been variously ascribed to a primary degenerative arteriosclerotic lesion,4, 5 to rheumatic fever,2, 6, 7 to congenital anomalies8 and to hypercholesterolemia.9, 10The typical case presents a history of...Bibliography1. McGinnWhite SPD: Clinical observations on aortic stenosis, Am. J. M. Sc. 188: 1-15, 1934. CrossrefGoogle Scholar2. KarsnerKoletsky HTS: Calcific disease of the aortic valve, 1947, J. B. Lippincott Company, Philadelphia. Google Scholar3. BergeronAbelmannVazquez-MilanEllis JWHHLB: Aortic stenosisclinical manifestations and course of the disease, Arch. Int. Med. 94: 911-924, 1954. CrossrefGoogle Scholar4. SohvalGross ARL: Calcific sclerosis of the aortic valve (Monckeberg type), Arch. Path. 22: 477-494, 1936. Google Scholar5. FriedbergSohval CKAR: Nonrheumatic calcific aortic stenosis, Am. Heart J. 17: 452-469, 1939. CrossrefGoogle Scholar6. Christian HA: Aortic stenosis with calcification of the cusps: distinct clinical entity, J. A. M. A. 97: 158-161, 1931. CrossrefGoogle Scholar7. DryWillius TJFA: Calcareous disease of the aortic valve: a study of 228 cases, Am. Heart J. 17: 138-157, 1939. CrossrefGoogle Scholar8. CampbellKauntze MR: Congenital aortic valvular stenosis, Brit. Heart J. 15: 179, 1953. CrossrefMedlineGoogle Scholar9. BoasElsterAdlersberg EPSKD: Calcific aortic stenosis: study of serum cholesterol, Am. Heart J. 48: 485, 1954. CrossrefMedlineGoogle Scholar10. BarrRothbardEder DPSHA: Atherosclerosis and aortic stenosis in hypercholesteremic xanthomatosis, J. A. M. A. 156: 943, 1954. CrossrefMedlineGoogle Scholar11. Wiggers CJ: Physiology in health and disease, 5th Ed., 1949, Lea and Febiger, Philadelphia. Google Scholar12. KumpeBean CWWB: Aortic stenosis: a study of the clinical and pathological aspects of 107 proven cases, Medicine 27: 139-185, 1948. CrossrefMedlineGoogle Scholar13. ClawsonNobleLufkin BJJFNH: The calcified nodular deformity of the aortic valve, Am. Heart J. 15: 58-76, 1938. CrossrefGoogle Scholar14. HoranBarnes MJAR: Calcareous aortic stenosis and coronary artery disease, Am. J. M. Sc. 215: 451, 1948. CrossrefMedlineGoogle Scholar15. Bean WB: Calcific aortic stenosis, Mod. Concepts Cardiovas. Dis. 25: 343-346, 1956. MedlineGoogle Scholar16. GorlinCase RRB: Clinical diagnosis of aortic valve disease, New England J. Med. 255: 368, 1956. CrossrefMedlineGoogle Scholar17. Sosman M: Roentgenological aspects of acquired valvular heart disease, Am. J. Roentgenol. 42: 47-56, 1939. Google Scholar18. Sosman M: The technique for locating and identifying pericardial and intra-cardiac calcification, Am. J. Roentgenol. 50: 461-468, 1943. Google Scholar19. LevineLikoff SAWB: Some notes on the transmission of heart murmurs, Ann. Int. Med. 21: 298, 1944. LinkGoogle Scholar20. MitchellSackettHunzickerLevine MACWJS: Clinical features of aortic stenosis, Am. Heart J. 48: 684, 1954. CrossrefMedlineGoogle Scholar21. BakerSpragueWhite LHBPD: Clinical significance of loud aortic and apical systolic murmur without diastolic murmur, Am. J. M. Sc. 206: 31, 1943. CrossrefGoogle Scholar22. BraunComeau HAWD: The importance of a high pitched squeaking systolic murmur in the diagnosis of aortic stenosis and calcification of the aortic valve, New England J. Med. 244: 507, 1951. CrossrefMedlineGoogle Scholar23. Flint A: On cardiac murmurs, Am. J. M. Sc. 44: 29-54, 1862. Google Scholar24. Willius FA: Cardiac clinics. LXIV. A talk on the aortic systolic murmur, Proc. Staff Meet., Mayo Clin. 14: 671, 1939. Google Scholar25. Sprague HB: The art of auscultation of the heart, Practitioner 176: 241, 1956. MedlineGoogle Scholar26. LevineHarvey SAPW: Clinical auscultation of the heart, 1949, W. B. Saunders Company, Philadelphia. Google Scholar27. Leatham A: Phonocardiogram of aortic stenosis, Brit. Heart J. 13: 153, 1951. CrossrefMedlineGoogle Scholar28. Levine SA: Clinical heart disease, 5th Ed., 1958, W. B. Saunders Company, Philadelphia. CrossrefGoogle Scholar29. LianWelti CJJ: Le claquement arterial pulmonaire protosystolique, Arch. d. mal. du coeur 30: 946, 1937. Google Scholar30. Leatham A: Splitting of the first and second heart sound, Lancet 2: 607, 1954. CrossrefGoogle Scholar31. ZinsserKay HFCV: The straining procedure as an aid in the anatomic localization of cardiovascular murmur and sound, Circulation 1: 523, 1950. CrossrefGoogle Scholar32. BarlowShillingford JJ: The use of amyl nitrite in differentiating mitral and aortic systolic murmurs, Brit. Heart J. 20: 162, 1958. CrossrefMedlineGoogle Scholar33. FeilKatz HSLN: The transformation of the central into the peripheral pulse in patients with aortic stenosis, Am. Heart J. 2: 12, 1926. CrossrefGoogle Scholar34. KatzRalliCheer LNEPS: The cardiodynamic changes in the aorta and left ventricle due to stenosis of the aorta, J. Clin. Investigation 5: 205, 1928. CrossrefMedlineGoogle Scholar35. SalansKatzGrahamGordonElisbergGerber AHLNGRAEIA: A study of the central and peripheral arterial pressure pulse in man, Circulation 4: 510, 1951. CrossrefMedlineGoogle Scholar36. Wiggers CJ: Circulatory dynamics, Modern medical monographs, 1952, Grune and Stratton, New York. Google Scholar37. Dow P: The development of the anacrotic and tardus pulse of aortic stenosis, Am. J. Physiol. 131: 432, 1940. CrossrefGoogle Scholar38. MoscovitzWilder HLRJ: The pressure events of the cardiac cycle in the dog: aortic valve lesions, Am. Heart J. 54: 572-579, 1957. CrossrefMedlineGoogle Scholar39. ReinholdRudheBonham-Carter JURE: The heart sounds and the arterial pulse in congenital aortic stenosis, British Heart J. 17: 327-336, 1955. CrossrefGoogle Scholar40. AravanisLuisada CAA: Obstructive and relative aortic stenosis, Am. Heart J. 54: 32, 1957. CrossrefMedlineGoogle Scholar41. Smith EJ: A technique for recording carotid artery pulsations with special reference to aortic stenosis, Am. Heart J. 49: 428, 1955. CrossrefMedlineGoogle Scholar42. DuchosalFerreroLeupinUrdaneta PWCAE: Advance in the clinical evaluation of aortic stenosis by arterial pulse recordings of the neck, Am. Heart J. 51: 861-879, 1956. CrossrefMedlineGoogle Scholar43. GoldbergBakstBailey HAAC: The dynamics of aortic valvular disease, Am. Heart J. 47: 527, 1954. CrossrefMedlineGoogle Scholar44. UricchioLitwakDentonGoldbergLikoff JFRCHW: A medical appraisal of transaortic commissurotomy in aortic stenosis, Ann. Int. Med. 44: 844, 1956. LinkGoogle Scholar45. HancockAbelmann EWWH: A clinical study of the brachial artery pulse form with special reference to the diagnosis of aortic valvular disease, Circulation 16: 572-581, 1957. CrossrefMedlineGoogle Scholar46. DoyleNelson AEGH: The Valsalva maneuver in aortic valve disease, Brit. Heart J. 19: 525, 1957. CrossrefMedlineGoogle Scholar47. RosenbergBraunStern SZKS: The effect of Priscoline on the arterial pressure pulse contour in aortic stenosis, Am. Heart J. 54: 118-126, 1957. CrossrefMedlineGoogle Scholar48. HancockMadisonProctorAbelmannStarkey EWWMMHWHGW: Aortic stenosis of no physiologic significance, New England J. Med. 258: 305-312, 1958. CrossrefMedlineGoogle Scholar49. Brock R: Surgical treatment of aortic stenosis, Brit. M. J. 1: 1019, 1957. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: New York, N. Y.*Presented as a Morning Lecture at the Thirty-ninth Annual Session of The American College of Physicians, Atlantic City, New Jersey, May 2, 1958.From the Division of Cardiology, University Hospital, The Postgraduate Medical School of New York University-Bellevue Medical Center, New York, N. Y.†Aided by grants from the William Haebler Fund and the New York Heart Association.Requests for reprints should be addressed to J. Scott Butterworth, M.D., University Hospital, 303 E. 20th St., New York, N. Y. 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