The Austin Flint Murmur: Its Differentiation from the Murmur of Rheumatic Mitral Stenosis

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Abstract
From information derived from a careful clinical evaluation of over 400 patients with severe aortic insufficiency criteria have been determined to differentiate the Austin Flint murmur from that of organic mitral stenosis. In those patients in the Austin Flint group (no organic mitral stenosis) the following pertinent features were noted: faint 1st sound at the apex, early diastolic gallop rhythm, early and mid-diastolic apical rumbling murmur, normal sinus rhythm, and ecg and X-ray evidence of left ventricular enlargement and strain. In those patients with free aortic insufficiency and associated mitral stenosis the following features were noted: loud 1st sound at the apex, opening snap of the mitral valve, diastolic rumble at the apex often with presystolic accentuation. Auricular fibrillation is common. The ecg often shows right axis deviation, notching and broad P-waves, and occasionally right ventricular hypertrophy. The X-ray shows straightening of the left cardiac silhouette due to pulmonary artery and left atrial enlargement.