WordNet

speak softly or indistinctly; "She murmured softly to the baby in her arms"
make complaining remarks or noises under ones breath; "she grumbles when she feels overworked" (同)mutter, grumble, croak, gnarl
a river in western Georgia that flows generally south to join the Chattahoochee River at the Florida border where they form the Apalachicola River (同)Flint River
a city in southeast central Michigan near Detroit; automobile manufacturing
a hard kind of stone; a form of silica more opaque than chalcedony
making a low continuous indistinct sound; "like murmuring waves"; "susurrant voices" (同)susurrant, whispering
state capital of Texas on the Colorado River; site of the University of Texas (同)capital of Texas

PrepTutorEJDIC

(流れる水・そよぐ葉などの)『ざわるき』,かすかな音;(人の声の)『ささやき』,ぼそぼそいう声《+『of』+『名』》 / 不平の声,ぶつぶつ言うこと / 〈川・風・木の葉などが〉『ざわめく』 / 〈人が〉『ささやく』,つぶやく / 《まれ》(…について)ぶつぶつ不平を言う《+『at』(『against, about』)+『名』》 / …‘を'『ささやく』,ぼそぼそと言う,小声で言う
火打ち石;ライターの石

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/08/04 11:29:15」(JST)

wiki en

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]

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 leaftlet displacement and turbulent mixing of antegrade 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] Ironically, he disapproved of associating any physical sign with the name of the original describer. As written by him “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

^ Flint A (1862). "On cardiac murmurs". American Journal of the Medical Sciences 44: 29–54.
^ 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
^ "Austin Flint murmur" at Dorland's Medical Dictionary
^ 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.
^ 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.
^ Weir RA, Dargie HJ (2008). "Austin Flint Murmur". New England Journal of Medicine 359 (10): e11. doi:10.1056/NEJMicm072437. PMID 18768939.
^ Austin Flint murmur at GPnotebook Accessed on: June 4, 2007.
^ Flint's murmur or symptom at Who Named It?
^ Austin Flint at Who Named It?
^ Landid HR, Austin F. His Contributions to the Art of Physical Diagnosis and the Study of Tuberculosus. Bull Johns Hopkins Hosp. 1912;23:182–6.

UpToDate Contents

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1. Auscultation of cardiac murmurs in adults
2. 成人における慢性大動脈弁閉鎖不全症の臨床症状および診断 clinical manifestations and diagnosis of chronic aortic regurgitation in adults
3. 心雑音および心音の鑑別診断における生理学的および薬理学的手法 physiologic and pharmacologic maneuvers in the differential diagnosis of heart murmurs and sounds
4. 小児における大動脈弁閉鎖不全 aortic regurgitation in children
5. 大動脈弁の心エコー評価 echocardiographic evaluation of the aortic valve

English Journal

Classics in cardiology: on cardiac murmurs(*) (part 3).

Flint A1.
Heart views : the official journal of the Gulf Heart Association.Heart Views.2012 Apr;13(2):77-83. doi: 10.4103/1995-705X.99236.
PMID 22919455

Classics in cardiology: on cardiac murmurs (part 2).

Flint A1.
Heart views : the official journal of the Gulf Heart Association.Heart Views.2012 Jan;13(1):26-8. doi: 10.4103/1995-705X.96669.
PMID 22754640

Classics in cardiology: on cardiac murmurs (part 1).

Flint A1.
Heart views : the official journal of the Gulf Heart Association.Heart Views.2011 Oct;12(4):185-90. doi: 10.4103/1995-705X.90912.
PMID 22574248

Japanese Journal

-P83-MECHANISM OF AUSTIN FLINT MURMUR IN MID-DIASTOLE AND IN PRE-SYSTOLE : Echocardiography, Pulsed Doppler : FREE COMMUNICATIONS(III) : PROCEEDINGS OF THE 53th ANNUAL SCIENTIFIC MEETING OF THE JAPANESE CIRCULATION SOCIETY

Suzuki Osamu,Itoh Kouichi,Shiina Akira,Fujita Toshihiro,Kuroda Toshio,Noda Toshitaka,Yaginuma Toshio
Japanese circulation journal 53(6), 662, 1989-06-20
NAID 110002631453

-71-INTRACARDIAC FLOW DYNAMICS AND THE AUSTIN-FLINT MURMUR : A STUDY WITH THE REAL-TIME TWO-DIMENSIONAL DOPPLER FLOW IMAGING

HIRAOKA Hisatoyo,MlYATAKE Kunio,IZUMI Shiro,MATSUHISA Mokuo,YAMAMOTO Katsuhiro,NAKAGAWA Hiroshi,MASUDA Kiichi,BEPPU Shintaro,PARK Yung-Dae,OMORI Fumio,KINOSHITA Naokazu,SAKAKIBARA Hiroshi,NIMURA Yasuharu
Japanese circulation journal 50(6), 479-480, 1986-06-20
NAID 110002585464

Quadrivalvular Heart Disease An Autopsied Case with Massive Pulmonary Regurgitation

Sakamoto Tsuguya [他],UOZUMI Zen'ichiro,KAWAI Nobuyoshi,SAKAMOTO Yoshiyuki,KATO Ryoko,UEDA Hideo
Ｊａｐａｎｅｓｅ　Ｈｅａｒｔ　Ｊｏｕｒｎａｌ 9(3), 303-315, 1968
An autopsied case of quadrivalvular heart disease was described, in which pulmonary regurgitation due to possible bicuspid valve was predominant and tricuspid stenosis, mitral stenosis, and aortic ste …
NAID 130000769464

Related Pictures

Austin Flint Murmur • LITFL • Medical Eponym Library April 2020 • Life in the Fast Lane • LITFL Austin Flint Murmur in Aortic Regurgitation - YouTube Austin Flint murmur is the mid diastolic murmur heard in mitral area in AR Soplo de Austin Flint - YouTube The Austin Flint Murmur Versus the Mitral Stenosis Murmur - Pulmonary Artery Aortic Regurgitation Exam | Stanford Medicine 25 | Stanford Medicine Soffio di austin flint, SHIKAKUTORU.INFO

★リンクテーブル★

リンク元	「大動脈弁閉鎖不全症」「オースチン・フリント雑音」「Flint murmur」
関連記事	「Flint murmur」

「大動脈弁閉鎖不全症」

　　[★]

日本では、英語表記ではaortic regurgitation AR、日本語表記では「大動脈弁閉鎖不全症」とするのが一般的？
同: 大動脈弁閉鎖不全症大動脈弁閉鎖不全 aortic valve insufficiency, AI
同: 大動脈弁逆流症大動脈弁逆流 aortic regurgitation AR, aortic valve regurgitation
関: 弁膜症

[show details]

ja

大動脈弁閉鎖不全症 : 約 28,700 件
大動脈弁閉鎖不全 : 約 41,400 件
大動脈弁逆流症 : 約 18,300 件
大動脈弁逆流 : 約 6,780 件

aortic valve insufficiency : 56 件
aortic insufficiency : 約 643 件
aortic valve regurgitation : 約 419 件
aortic regurgitation : 約 1,830 件

en

aortic valve insufficiency : 約 125,000 件
aortic insufficiency : 約 89,400 件
aortic valve regurgitation : 約 125,000 件
aortic regurgitation : 約 183,000 件

概念

大動脈弁の閉鎖不全により、拡張期に大動脈の血液が左心室に逆流する病態。
左室の容量負荷が特徴

身体所見

聴診

心音：S1↑, S2？, S3？,S4？

参考6

S1：soft
S2：variable
A2：soft～absent
P2：normal
S3：左心機能が落ちれば聴取される

心雑音

拡張期逆流性雑音 = 拡張期灌水様雑音 = blowing murmur in early diastole along the left sternal border

最強点：3LSB。

持続時間：軽症・急性型では持続時間は短い。

音量は一定かだんだん小さくなる(decrescendo)

重症度と音量は相関しないが、雑音の持続時間は参考になる。軽症では拡張期の初期にのみ吹くような(blowing)音が聴取される。重症になるにつれだんだん伸びていき、しまいには拡張期全体に聴取されるようになり、音は粗な音である(rougher)。

(参考6) :::持続時間は重症度を反映しないが、軽度ARでは持続時間は短い(なぜ?)。また急性ARでも短いが、これは拡張期にすぐに大動脈と左心室の圧が均衡するからである(圧較差が小さいということか？)。(up2date)

Austin Flint murmur：拡張期中期に低音を心尖で聴取。拡張期に大動脈弁から逆流してくる血液の乱流により、僧帽弁前尖が下方に押し下げられMS様の雑音を生じる。Austin Flint雑音はMSと違ってopening snapがなく、収縮期前期の雑音の増強がない。(PHD.214)

特徴的な身体所見 PHD.215

二峰性脈	bisferiens pulse	頚動脈や腕頭動脈で収縮期に二峰性の脈を感じる
コリガン脈	Corrigan pulse	著しく膨張し虚脱する脈
ミュッセ徴候	de Musset sign	収縮期に頭が上下に動く
デュロジェ雑音	Duroziez sign	大腿動脈を軽く押さえると往復雑音が聴取される
ヒル徴候	Hill sign	収縮期の膝窩動脈圧が上腕動脈圧よりも60mmHg高い
ミュラー徴候	Muller sign	uvulaの収縮期のは駆動
クインケ徴候	Quincke sign	口唇や近位爪床で毛細血管の拍動が見える
トラウベ徴候	Traube sign	Pistol-shot音が大腿動脈で聴取される

末梢の症状にトラウベ徴候、デュロジェ雑音、コリガン脈(water hammer pulse)があるが、これらは慢性ARでは特徴的だが、急性ARではほとんど見られない。急性ARではstroke volume and diastolic filling volumeが増えないためである(uptodate)