Austin flint murmur vs. mitral stenosis

Diagnostic

Austin

Shelf

Flint

Murmur

vs. Mitral

M.D., F.A.C.C. and A. JACONO, M.D.

A. A. ISX4D.4,

Chicago,

A

57-year-old

colored

to the hospital

widow

increasing

exertional

dyspnea

nocturnal

dyspnea.

The

she had contracted thought

been informed

The chest x-ray with barium

of

diffuse enlargement

and paroxysmal

patient

knew

dilatation

that

and

cure had been obtained The patient had

of bismuth.

tion,

that she had high blood pressure

in 1947, but she did not receive This history was otherwise

of the esophagus

a moderately-

electrocardiogram

enlarged

minimal

dis-

by the aortic

arch,

left atrium.

The

left axis devia-

hypertrophy

P waves and P-R

first sound occurred

noncontributory.

an aneurysmal

aorta,

showed moderate

left ventricular

and normal

any treatment.

swallow showed a

of the heart,

of the ascending

placement

syphilis 15 years before and

that a complete

with 12 injections

history

Illinois

LABORATORY TESTS

was admitted

with a two-year

Stenosis

and

strain,

interval.

The

0.09 set after the Q wav’e of

the ECG. PHYSICAL ExAMINATION The

patient

was a well-developed with

no

and well-

nourished

female

peripheral

pulses were full and bouncing.

pulse was 100 and regular, sure was 180/90. apical apex

thrust line.

percussed

right

2 cm outside

Palpation

cardiac

the

border

tion below the lower part of the sternum.

There

was a soft,

murmur

in de-

precordium,

louder

crescendo

blowing over

over the aortic faint

systolic

diastolic

the entire area.

murmur

diastolic-presystolic sound accentuated

Other

findings

over

the aortic

were: area,

at the midprecordium

Various brevity.

of the sterpulsa-

murmur

presystolic

murmur

at the base and a and

studies made on the blood and urine

were not contributory

was

a prominent

of an early-diastolic apex (Fig. 1).

the 6th rib at the

the margin

revealed

The

or palpable;

of an opening

snap and of gallop sounds, and gives the evidence

The

were no thrills.

below

The

The tracing reveals the absence

The

and the blood pres-

was not visible

was percussed

axillary num.

There

orthopnea.

The

various

and are not reported serologic

reactions

for for

syphilis were negative. DISCUSSION At this point terpretation

the general

in-

of the case was that the patient

of the study,

had

a

syphilitic

a

of the ascending

aorta,

Problems

were not solved were the fol-

rumble at the apex, 2nd and “tambour-like” over the

heart which

disease with aortitis,

aneurysm

and aortic insufficiency.

area, and 1st sound accentuated at the The liver was palpable one finger below apex. The jugular veins were the right costal margin.

lowing: (1) Has the patient also rheumatic heart disease; if so, has she mitral stenosis? (2) Has the patient atherosclerosis of the aorta, causing some degree of obstructing aortic

not engorged, but there was a positive hepatojugular reflux.

stenosis? (3) If not, Austin Flint murmur?

aortic

APRIL,

1959

565

has the patient

only an

Austin

566

Flint

Murmur

vs. Mitral

Stenosis

left

I:is. 2 I,cft heart cathetrrization. Pullback from LV to LA; no diastolic gradient across the mitral valw.

For tht, al)ovc reasons,

il was dccidcd

to

addition

per-

10 aortic

This rcvc*alcd th(z a lrfi fvart catheterization. of aortic stcfollowing data : (1) no cvidrncc

of an opwing

nosis,

lack of c\.idrncc

fowl

as indicated

gradirnt

Iwtween

no Initral atrium

lack

of any

left vcntriclr

stenosis,

any diastolic Irft

by the

and

as indicated

systolic

aorta;

I))- the

(3)

lack

of

gradient

hctwcen Icft \.cntriclc and and (3) no cvidcncc 01 2);

(Fig.

mitral

insufficiency,

vation

of the

as indicated

normal

curve prcssurc phonocardiography murlnur

\vithin

diastolic

murmur

(Fig.

I))- the

pattwn

in

2).

(4)

rcvealcd within

Irft atria1 Intracardiac

the

a Ininimal

the left atrium

prcscr-

systolic

and a modcratc

the left

ventricle.

In conciusion, it was felt that the diastolicprcsystolic murmur was an Austin Flint murmur, caused

b)- eddies

which

formed

ivithin

the dilated

left \rcntriclc, and that therr was a modrratc left ventricular failure (diastolic prrssurc \?;ithin the left vcntriclc was from 5 to 20 mm Hg). In rctrospcct, it is apparent that wcrt‘ against the cxistcncc of mitral

many data stenosis (in

lack

insutliciwc\.j?

snap

such as the lack

and of a split 2nd sound,

of al)normalitics

of the

P \vavrs,

the

and

the

of rig-ht ventricular h>~pcrtroph) The wlarq:rmcnt 01 in the rl~ctrocardiog-rain. ‘I‘hcx thr right twit-t \~;ts logically dur to failurc.

prolongation sidcrrcl

of

sp<‘cific

Q-1

interval.

once

for mitral

thr

stenosis,

is now

WrprctVcl

8s I)ciny

found

in

hi-pc.rtcnsion

which

I(,ft wntricular

nonspw3ic or

and

other

h> pcrtroph!-

CUII-

in-

frcqwntl!

conditions occurs.

in Th(,

fart that rlw diastolic prcssuw, arm, 1~;~s not too IOLV could 1~. coml)ination of Icft \~rntricular The pulse temic hg>wtcnsion.

mrasurcd at the. explained t)y the failure and syspresurc bsas ac‘I‘he high normal.

tually still much lrvcl of diastolic

laqrr than prcssurr in the left vcntriclc

partI!, cxplaincd aorta and partI\-

t))- the regurgitant I)\- left \.tlntricular

patient course impro\wl.

is

,jct from the The failure.

was diqitalizcd and advised to recci\.r a She bvcnt home of penicillin injections.