Degenerative Calcific Valvular Disease and Systolic Murmurs in the Elderly

Abstract

By use of echocardiographic and radiologic imaging, a prospective study was made of 98 elderly men, 65 to 102 years old, to define degenerative calcific valvular disease (DCVD)--its prevalence, morphologic features, functional significance, and relationship to systolic murmurs in the elderly. DCVD was diagnosed in 74 per cent of the group and murmurs were detected in 55 per cent, the incidences increasing with age. Fibrotic and calcific change of the aortic valve was the most common abnormality, occurring alone or together with alteration of the mitral valve. The murmurs were characteristically early systolic, of low intensity and medium pitch, and heard at more than one area. Of the group with valve degeneration, only 7 per cent was judged to be functionally significant and no more than moderate. It was concluded that DCVD is the cause of most systolic murmurs in the elderly and is usually hemodynamically unimportant. Echocardiographic criteria are important in identifying those subjects with possibly significant valvular dysfunction requiring invasive study.

Infective Endocarditis in the Elderly: Diagnosis and Management

“…The prevalence of “innocent” cardiac murmurs also increases in this population, particularly due to degenerative calcification of the aortic or mitral valve. One survey 28 found that 58% of elderly patients in a Veterans' hospital had some type of a cardiac murmur, the majority of which were of a low intensity and easily overlooked on physical examination. Much of the emphasis in the older endocarditis literature placed on a changing cardiac murmur as an important diagnostic tool must be viewed in this context.…”

Tumor microenvironment and immune evasion in head and neck squamous cell carcinoma

“… 109 , 110 Hypoxia-inducible family (HIF) expression in hypoxic regions, which can be activated by EGFR signaling, have been reported to regulate cellular functions such as metabolism, proliferation, and remodeling. 111 A significant increase in EGFR expression is commonly observed in HNSCC, particularly HPV − patients, and is correlated with a poor outcome. 112 Interestingly, not only has hypoxia been reported to induce EGFR expression, it has also been shown to promote immunosuppression, through the expression of cytokines, impeding T-lymphocyte proliferation, recruitment of immunosuppressive cells, and upregulation of PD-L1.…”

Infective Endocarditis in the Aging Patient

“…Unfortunate ly, in the elderly a murmur may be absent or when present, is frequently attributed to de generative or atherosclerotic valve disease or is considered hemodynamically insignificant. However, murmurs due to degenerative cal cific valvular disease, which are characteristi cally early systolic, low intensity, and me dium pitch, can be usually distinguished from an early diastolic murmur of aortic insufficiency [66], The changing character of heart murmurs is probably overemphasized and can be demonstrated only in a minority of patients with IE [48].…”