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Q J Med 2000; 93: 685-688
© 2000 Association of Physicians

Commentary papers

The patient with a systolic murmur: severe aortic stenosis may be missed during cardiovascular examination

P. Das, C. Pocock and J. Chambers

From the Department of Cardiology, Guy's and St. Thomas' Hospitals, London, UK

Summary

Significant aortic stenosis is prevalent amongst elderly people. It may be subclinical, manifesting only as a murmur, but can still cause unexpected death with little warning after symptoms develop. Recent studies have highlighted the unreliability of the classical clinical signs of severe aortic stenosis, leading to concern that some patients may not be referred appropriately for echocardiography. Here, we review the evidence for the accuracy of each sign. We suggest that the assessment of the patient with a systolic murmur should be reappraised, and offer guidelines toward improving the recognition of aortic stenosis in the community.

Notes

Address correspondence to Dr P. Das, Department of Cardiology, 6th Floor, East Wing, St. Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH. e-mail: pauldas{at}compuserve.com


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