Murmurs Associated with Mitral Annular Calcification and Aortic Sclerosis

Abstract

Background: Auscultation of patients with mitral annular calcification on echocardiography revealed a particular constellation of findings. Objective: To test the hypothesis that a particular auscultatory constellation provides a high degree of certainty in diagnosing the combination of mitral annular calcification and aortic sclerosis so often found in the elderly. Methods: Two groups of patients were studied to evaluate the particular auscultatory constellation under consideration which consisted of: (1) a harsh ejection systolic murmur heard from the 2nd right interspace to the cardiac apex and usually loudest between the 3rd left interspace and the apex; (2) the murmur radiates from the apex towards the left axilla and radiates poorly or not at all from the 2nd right interspace to the neck, and (3) the 2nd heart sound at the cardiac base is normal in intensity, and no ejection clicks are present. Group 1 consisted of patients with mitral annular calcification on echocardiographic examination, and group 2 consisted of patients in whom the particular constellation of auscultatory findings was present and who were then referred for echocardiographic assessment. Results: The particular auscultatory constellation under investigation allowed the diagnosis of the presence of the combination of mitral annular calcification and aortic sclerosis with substantial accuracy. Conclusion: The findings in this exploratory study suggest that the pathologic combination of mitral annular calcification and aortic sclerosis can be diagnosed with a reasonably high degree of certainty in elderly patients, if the particular auscultatory configuration is identified.

Impact of Cardiac Physical Examination Faculty Development on Medical Student Performance: A Randomized Trial

“…The second component was 90 min of deliberate practice [10] of the cardiac physical examination facilitated by a senior cardiologist (IMG) at the bedside of a standardized patient without known cardiac disease. This cardiologist was selected for his 40 years of clinical experience, scholarly work about the physical examination [11][12][13], and prior recognition for leadership in cardiology education. The cardiologist demonstrated cardiac physical examination techniques, relayed practical teaching points, and provided individualized feedback to hospitalists as they practiced cardiac physical examination skills.…”