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Slagbilsóhljóð aldraðra á íslensku bráðasjúkrahúsi : algengi, orsakir og áreiðanleiki klínískrar greiningar

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Authors
Tryggvi Þ. Egilsson
Torfi Fjalar Jónasson
Gizur Gottskálksson
Pálmi V. Jónsson
Issue Date
1996-09-01

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Other Titles
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
Citation
Læknablaðið 1996, 82(9):636-41
Abstract
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° 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.
Tilgangur rannsóknarinnar var að meta faraldsfræði, orsakir, næmi og sértæki klínísks mats slagbilsóhljóða aldraðra. Rannsóknin tók til 101 sólarhrings frá febrúar 1993 til febrúar 1994. Efniviðurinn var 213 sjúklingar eldri en 80 ára innlagðir bráðainnlögn á lyflækningadeild Borgarspítalans. Sextán voru útilokaðir vegna þekktra hjartalokusjúkdóma en ekki náðist að skoða aðra 44 af ýmsum óviðráðanlegum orsökum. Deildarlæknir skoðaði 153 sjúklinga, meðalaldur var 85 ±4 ár (á bilinu 79-101), 61% voru konur. Síðan voru allir tiltækir sjúklingar með slagbilsóhljóð hlustaðir af tveimur sérfræðingum og gerð tvívíddar- og Dopplerómun af hjarta. Deildarlæknir greindi slagbilsóhljóð hjá 80 sjúklingum, það er 53% áttræðra og eldri sem hlustaðir voru, 61% kvenna en 40% karla, kynstaðlað (p<0,025). Hjartaómskoðun var gerð hjá 57 og greindust átta (14%) með ósæðarþröng, skilgreind sem hámarksþrýstingsfall ^30 mmHg; 44 (77%) höfðu ósæðarlokukölkun með minna þrýstingsfalli, en 25 (44%) höfðu míturlokuleka, þar af 1° af 4° í 19 af 25 tilfellum. Næmi og sértæki klínískrar skoðunar lækna með tilliti til ómskoðunar var: Fyrir ósæðarþröng, næmi 62-100% og sértæki 71-77%, fyrir ósæðarlokukölkun, næmi 54-56%, sértæki 85-92% og fyrir míturlokuleka, næmi 24-52%, sértæki 69-97%. Slagbilsóhljóð eru algeng hjá öldruðum, algengari í konum en körlum og tengjast oftast ósæðarlokukölkun en þó í umtalsverðum minnihluta ósæðarþröng. Tvívíddar- og Dopplerómun er hjálpleg við greiningu á ósæðarþröng, í ljósi þess að greiningin er erfið, þar sem ósértæk slagbilsóhljóð ósæðarlokukölkunar og minni háttar míturlokuleki eru yfirgnæfandi algeng. Niðurstöðurnar eru sambærilegar við það sem lýst hefur verið í erlendum rannsóknum.
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