Austin Flint murmur

In cardiology, an Austin Flint murmur is a low-pitched rumbling heart murmur which is best heard at the cardiac apex.[1] It can be a mid-diastolic[2] or presystolic murmur[3] It is associated with severe aortic regurgitation, although the role of this sign in clinical practice has been questioned.[4]

Austin Flint murmur
Differential diagnosisaortic regurgitation

Mechanism

Echocardiography, conventional and colour flow Doppler ultrasound, and cine nuclear magnetic resonance (cine NMR) imaging suggest the murmur is the result of (aortic regurgitant) flow impingement on the inner surface of the heart, i.e. the endocardium.[5][6]

Classical description

Classically, it is described as being the result of mitral valve leaflet displacement and turbulent mixing of anterograde mitral flow and retrograde aortic flow:[7]

Displacement: The blood jets from the aortic regurgitation strike the anterior leaflet of the mitral valve, which often results in premature closure of the mitral leaflets. This can be mistaken for mitral stenosis.

Turbulence of the two columns of blood: Blood from left atrium to left ventricle and blood from aorta to left ventricle.

Name

The Austin Flint murmur is named after the 19th century American physician, Austin Flint (1812–1886).[8][9] He disapproved of associating any physical sign with the name of the original describer, and wrote, "So long as signs are determined from fancied analogies, and named from these or after the person who describes them, there cannot but be obscurity and confusion."[10]

References
  1. Flint A (1862). "On cardiac murmurs". American Journal of the Medical Sciences. 44: 29–54.
  2. Eric J. Topol. The Topol Solution: Textbook of Cardiovascular Medicine, Third Edition with DVD, Plus Integrated Content Website, Volume 355. Lippincott Williams & Wilkins, Oct 19, 2006; page 223. ISBN 0781770122
  3. "Austin Flint murmur" at Dorland's Medical Dictionary
  4. Babu AN, Kymes SM, Carpenter Fryer SM (2003). "Eponyms and the diagnosis of aortic regurgitation: what says the evidence?". Annals of Internal Medicine. 138 (9): 736–742. doi:10.7326/0003-4819-138-9-200305060-00010. PMID 12729428. S2CID 19014006.
  5. Landzberg JS, Pflugfelder PW, Cassidy MM, Schiller NB, Higgins CB, Cheitlin MD (1992). "Etiology of the Austin Flint murmur". Journal of the American College of Cardiology. 20 (2): 408–413. doi:10.1016/0735-1097(92)90110-9. PMID 1634679.
  6. Weir RA, Dargie HJ (2008). "Austin Flint Murmur". New England Journal of Medicine. 359 (10): e11. doi:10.1056/NEJMicm072437. PMID 18768939.
  7. "Austin Flint murmur". GPnotebook. Retrieved June 4, 2007.
  8. Flint's murmur or symptom at Who Named It?
  9. Austin Flint at Who Named It?
  10. Landis, H.R.M. (1912). "Austin Flint: His Contributions to the Art of Physical Diagnosis and the Study of Tuberculosis". Bulletin of the Johns Hopkins Hospital. 23: 182–186.
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