Obstructive and relative aortic stenosis. Differential diagnosis by phonocardiography

Abstract

Seventy clinical cases with loud aortic systolic murmurs were investigated by clinical, roentgenologic, and graphic means. The tracing of the suprasternal notch, the carotid tracing, and the aortic kymogram presented data (slow rise, flat top, or anacrotic notch, multiple vibrations) which were helpful in the differential diagnosis between obstructive stenosis, minor nonobstructive aortic lesions, and relative aortic stenosis. The phonocardiogram revealed that no statistical significance could be attached to the amplitude of the murmur and its distance from the first and second sound, or to the magnitude of the second aortic sound. The shape of the murmur, on the contrary, seemed important since 87.5 per cent of the cases with relative stenosis had an “early diamond” and 66.7 per cent of the cases with organic stenosis had a “late diamond.” A late beginning and a late termination of the murmur, and a small, delayed second aortic sound are found more often in organic, obstructive valvular stenosis than in relative or nonobstructive stenosis.