[Systolic murmurs of the elderly in an Icelandic acute care hospital: prevalence, etiology by 2D- and Doppler echocardiography and sensitivity and specificity of clinical assessment.].

Acutely hospitalised elderly patients, from February 1993 to February 1994, excluding those with known valvular heart diseases, were examined by a resident. Those who had a systolic murmur were also auscultated by a cardiologist and a geriatrician and studied with 2D- and Doppler echocardiography. Of 213 potential study participants the resident auscultated 153 patients, 79-101 years old, with the mean age of 85+/-4 years, 61% of whom were women. Systolic murmurs were diagnosed in 80 of 153 patients or 53% of over the age of 80, 61% of women and 40% of men adjusted for sex (p<0,025). Fifty seven patients with systolic murmurs were evaluated with 2D- and Doppler echocardiography. Maximal Doppler gradients 3=30 mmHg, representing significant aortic stenosis were found in 8/57 subjects (14%), aortic sclerosis in 44 (77%), and mitral regurgitation in 25/57 (44%); 1 degrees on the scale of 1-4 in 19 of 25. The sensitivity and specificity of clinical examination for the detection of aortic stenosis was 62-100% and 71-77%, aortic sclerosis 54-56% and 85-92% and mitral regurgitation 24-52% and 69-97%, respectively. Systolic murmurs are prevalent in the aged and more so in women than men. 2D- and Doppler echocardiography is of value since the clinical diagnosis of aortic stenosis is difficult in light of the high prevalence of systolic murmurs most of which are due to aortic sclerosis or clinically nonsignificant mitral regurgitation. The results are comparable with other reported studies.