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. 2006 Dec 5;27(9):502–506. doi: 10.1002/clc.4960270905

A systolic murmur is a common presentation of aortic regurgitation detected by echocardiography

Paul A Heidenreich 1,2,✉, Ingela Schnittger 2, Stsven L Hancock 3, J Edwin Atwood 1,2
PMCID: PMC6654102  PMID: 15471160

Abstract

Background: The finding of aortic regurgitation at a classical examination is a diastolic murmur.

Hypothesis: Aortic regurgitation is more likely to be associated with a systolic than with a diastolic murmur during routine screening by a noncardiologist physician.

Methods: In all, 243 asymptomatic patients (mean age 42 ±10 years) with no known cardiac disease but at risk for aortic valve disease due to prior mediastinal irradiation (≥ 35 Gy) underwent auscultation by a noncardiologist followed by echocardiography. A systolic murmur was considered benign if it was grade ≤ II/VI, not holosystolic, was not heard at the apex, did not radiate to the carotids, and was not associated with a diastolic murmur.

Results: Of the patients included, 122 (49%) were male, and 86 (35%) had aortic regurgitation, which was trace in 20 (8%), mild in 52 (21%), and moderate in 14 (6%). A systolic murmur was common in patients with aortic regurgitation, occurring in 12 (86%) with moderate, 26 (50%) with mild, 6 (30%) with trace, and 27 (17%) with no aortic regurgitation (p < 0.0001). The systolic murmurs were classified as benign in 21 (78%) patients with mild and 8 (67%) with moderate aortic regurgitation. Diastolic murmurs were rare, occurring in two (14%) with moderate, two (4%) with mild, and three (2%) with no aortic regurgitation (p = 0.15).

Conclusions: An isolated systolic murmur is a common auscultatory finding by a noncardiologist in patients with moderate or milder aortic regurgitation. A systolic murmur in patients at risk for aortic valve disease should prompt a more thorough physical examination for aortic regurgitation.

Keywords: aortic valve insufficiency, heart murmurs, echocardiography, heart auscultation

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