The Austin Flint Murmur and the a Wave of the Apexcardiogram in Aortic Regurgitation

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Abstract
Hemodynamic data from 45 patients with either aortic regurgitation (with and without the Austin Flint murmur) or aortic regurgitation and mitral stenosis were correlated with the a -wave percentage amplitude of the apexcardiogram. Changes in the a wave correlated well with corresponding changes in left heart pressures but not with variations in volume. Of 15 patients in whom the ratio of the a wave to the total excursion during systole ( a /H ratio) was [See Equation in PDF file]13%, 11 had left ventricular end-diastolic pressures (LVEDP) >20 mm Hg. All patients with a /H ratios >15% had abnormal LVEDP. The converse was not true; 13 patients had elevated LVEDP with normal a /H ratios. Patients with aortic regurgitation and mitral stenosis had a /H ratios similar to those of normal subjects. The Flint murmur showed a significant correlation with left ventricular volume changes. Its presence was valuable in prediction of a large regurgitant volume and a high left ventricular stroke volume. It was also present in association with elevated left atrial mean pressure and elevated LVEDP. Thus, two ancillary findings in aortic regurgitation, a high a wave in the apexcardiogram and the Austin Flint murmur, are of value in anticipating alterations in left ventricular hemodynamics as determined by left-sided catheterization and volume studies.