The Rational Clinical Examination
David L. Simel, Drummond Rennie
Murmur, Systolic
David Cescon, Edward Etchells, Eugene Oddone
Make the Diagnosis: Murmur, Systolic
Topics Discussed:
aortic valve stenosis, echocardiography, innocent murmurs, likelihood ratio, make the diagnosis, mitral valve insufficiency, mitral valve prolapse, prior probability, systolic heart murmur
Excerpt:
"Systolic murmurs are common, and echocardiography is normal in
the majority of asymptomatic individuals with murmurs. Clinical evaluation
offers the potential to identify those patients with increased likelihood
of underlying structural disease and to avoid costly echocardiographic
evaluation in all patients with systolic murmurs.One study of randomly selected elderly Finnish persons (aged
75-86 years) found a prevalence of moderate to severe AS of 8.8% in women
and 3.6% in men.10 The prevalence in younger
patients ought to be less. The Framingham Heart Study showed that echocardiographic
evidence of MR is common and a function of both age and sex.11 A
useful approximation for the prevalence of mild to moderate MR is
15% from age 40 to 60 years for both men and women. After
age 60, women have a prevalence of about 25% compared with
men, who have an increasing frequency of MR that approximates 40% by
age 80 years. The prevalence of MVP is about 2.5%.12,13..."
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