Significance of Systolic Murmurs in the Aged

A prospective study of the heart murmurs in 30 elderly patients, none of whom had a history of rheumatic heart disease, was undertaken by use of phonocardiography, carotid-pulse recording and amyl nitrite. Systolic ejection murmurs were recorded in 29 patients, 24 increasing in intensity with amyl nitrite inhalation. Twelve had abnormal carotid-pulse tracings typical of aortic stenosis. There were few of the usual associated clinical findings of aortic stenosis. Other findings such as atrial gallops and diastolic murmurs were not infrequent. It appears that the degenerative changes seen at the aortic valve in the aged not only cause enough turbulence for a murmur to occur but may frequently obstruct the aortic valve.