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首页> 外文期刊>The American Journal of Medicine >Etiology and diagnosis of systolic murmurs in adults.
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Etiology and diagnosis of systolic murmurs in adults.

机译：成人收缩期杂音的病因学和诊断。

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BACKGROUND: It is unknown whether echocardiography can provide insights into the origin of systolic murmurs and the modern value of bedside cardiovascular diagnosis. METHODS: The author examined 376 inpatients and compared their physical findings to transthoracic echocardiography, exploring the associations between echocardiography and systolic murmurs and investigating the diagnostic accuracy of physical examination for pathologic murmurs. RESULTS: Four echocardiographic variables predict the presence of systolic murmurs: peak aortic velocity (P <.001); mitral regurgitation severity (P <.001); mitral valve E-point velocity (P=.09); and absence of pericardial effusion (P=.09). When diagnosing murmurs, the most helpful finding is its distribution on the chest wall with respect to the 3(rd) left parasternal space, a landmark that distinguishes murmurs into 6 patterns. The "apical-base" pattern indicates increased aortic velocity (likelihood ratio [LR] 9.7; 95% confidence interval [CI]; 6.7-14): a delayed carotid upstroke (LR 6.8; 95% CI; 4.0-11.5); absent S2 (LR 12.7; 95% CI; 5.3-30.4); and humming quality to the murmur (LR 8.5; 95% CI; 4.3-16.5) further increase the probability of aortic valve disease. The "broad apical" murmur pattern suggests significant mitral regurgitation (LR 6.8; 95% CI; 3.9-11.9); and the "left lower sternal" murmur pattern indicates significant tricuspid regurgitation (LR 8.4; 95% CI; 3.5-20.3): additional bedside observations refine these diagnoses. Nonetheless, this study shows that some classic physical findings are no longer accurate, that physical examination cannot reliably distinguish severe aortic stenosis from less severe stenosis, and that classic physical findings, despite having proven value, are absent in many patients with significant cardiac lesions. CONCLUSIONS: In the diagnosis of systolic murmurs, physical examination has limitations but also unappreciated value. A simple system using onomatopoeia and classifying systolic murmurs into 1 of 6 patterns is diagnostically helpful.
机译：背景：超声心动图能否提供有关收缩期杂音的起源和床旁心血管诊断的现代价值的信息尚不清楚。方法：作者对376名住院患者进行了检查，并将他们的体格检查结果与经胸超声心动图进行了比较，探讨了超声心动图与收缩期杂音之间的关系，并研究了体检对病理性杂音的诊断准确性。结果：四个超声心动图变量预测收缩期杂音的存在：主动脉峰值速度（P <.001）;二尖瓣关闭不全的严重程度（P <.001）;二尖瓣E点速度（P = .09）;无心包积液（P = .09）。诊断杂音时，最有帮助的发现是相对于左胸骨旁第3个空间，其在胸壁上的分布，这是将杂音分为6种模式的标志。 “根尖”模式表明主动脉速度增加（可能性比[LR] 9.7; 95％置信区间[CI]; 6.7-1）：颈动脉中风延迟（LR 6.8; 95％CI; 4.0-11.5）;没有S2（LR 12.7; 95％CI; 5.3-30.4）;杂音的嗡嗡声（LR 8.5; 95％CI; 4.3-16.5）进一步增加了主动脉瓣疾病的可能性。 “广泛的顶端”杂音模式提示明显的二尖瓣关闭不全（LR 6.8; 95％CI; 3.9-11.9）;而“左下胸骨”杂音模式则表明存在明显的三尖瓣关闭不全（LR 8.4; 95％CI; 3.5-20.3）：其他床旁观察可改善这些诊断。尽管如此，这项研究表明，一些经典的物理检查结果不再准确，物理检查不能可靠地将严重的主动脉瓣狭窄与较轻的狭窄区别开来，尽管经典的物理检查结果尽管已被证实具有价值，但在许多患有严重心脏病变的患者中却不存在。结论：在诊断收缩期杂音时，体格检查有局限性，但价值不高。使用拟声词并将收缩期杂音分类为6种模式中的一种的简单系统在诊断上很有帮助。

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