Mitral annular calcification: a cause of systolic murmur in the elderly.

Mitral annular calcification is predominantly a disease of females, typically above 65 years of age. The diagnosis should be considered in patients with a systolic murmur which is mitral in origin. This murmur is caused by mitral regurgitation due to loss of the sphincter action of the mitral annulus. Diagnosis is made by one- or two-dimensional echocardiography. Calcification in the mitral ring may be seen on chest x-ray films or fluoroscopy. Management includes antibiotic prophylaxis to avoid infective endocarditis and observation for the development of congestive heart failure. Conventional management with digitalis and diuretics is supplemented with use of vasodilators in severe cases.