Austin Flint Murmur: Mid diastolic, low pitch rumble murmur heard best at the apex with the patient leaning forward and breathing out
Mechanism: Occurs in aortic regurgitation as a result of the vibration of the anterior leaflet of the mitral valve due to the regurgitant jets from the left atrium and aorta. The striking of these regurgitant jets often cause the premature closure of the mitral leaflets, commonly mistaken for mitral stenosis.
Sign Value: Opinions vary, most likely to be heard in the setting of severe AR. Sensitivities range from 25 to 100% depending on the study. One review suggested the murmur to predict moderate-severe AR with a likelihood ratio of 25.
- The absence of an opening snap and loud S1 distinguishes the pure aortic regurgitation of an Austin flint murmur from that of mitral stenosis
- An ECG may show a sinus rhythm with left ventricular hypertrophy, left axis deviation and prolonged PR interval.
1862 – Flint published his extremely detailed account ‘On Cardiac Murmurs‘ and in depth analysis of cardiac murmurs in the setting of valvular heart disease. He described, for the first time, a presystolic murmur in the setting of aortic regurgitation.
The murmur is oftener rough than soft. The roughness is often peculiar. It is a blubbering sound, resembling that produced by throwing the lips or the tongue into vibration with the breath of respiration[On Cardiac Murmurs 1862 p50]
Two patients, both with signs of with aortic regurgitation and aortic stenosis, and with the described distinct presystolic murmur at the apex were found to have normal mitral valves without gross pathology at postmortem.
“In some cases in which free aortic regurgitation exists, the left ventricle becoming filled before the auricles contract, the mitral curtains are floated out and the valve closed when the mitral current takes place, and, under the circumstance, the murmur may be produced by the current just named, although no mitral lesion exists.[On Cardiac Murmurs 1862 p53]
- Austin Flint (1812-1886)
- Rufus Cole (1872-1966) and the Cole-Cecil murmur (1908)
- Arthur Bond Cecil (1885-1967)
- Flint A. A Practical Treatise on the Diagnosis, Pathology and Treatment of Diseases of the Heart. Blanchard and Lea, 1859.
- Flint A. On Cardiac Murmurs. American Journal of the Medical Sciences. 1862;44:29-54.
- Babu, Ajit, Steven Kymes, and Sharon M. Carpenter Fryer. Eponyms and the diagnosis of aortic regurgitation: what says the evidence?. Annals of internal medicine 138.9 (2003): 736.APA
- Desjardins VA, Enriquez-Sarano M, Tajik AJ, Bailey KR, Seward JB. Intensity of murmurs correlates with severity of valvular regurgitation. The American journal of medicine. 1996 Feb 1;100(2):149-56.
- Zhang G. Eponyms in Aortic Regurgitation. LITFL 2019
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