Blumgart-Ernstene murmur

Description

Duroziez-type murmur auscultated with the patients arm subjected to various temperatures of water and by applying a subdiastolic pressure below the auscultation site, to help differentiate between aortic insufficiency and peripheral vasodilatation.

We have used the Peabody bell stethoscope during the course of this investigation because it seemed most suited to the elucidation of the phenomena under investigation

In patients with peripheral vasodilatation (thyrotoxicosis, anemia, fever, normal subjects with increased local blood flow due to immersion of the limb in hot water), the diastolic arterial murmur is due to an increased forward flow of blood toward the periphery during diastole. The diastolic murmur is increased by pressure with the upper edge of the stethoscope, while the murmur is abolished by immersion of the limb in cold water or by application of subdiastolic pressure distal to the site of auscultation.

In patients with aortic régurgitation, the diastolic arterial murmur elicited by pressure on the artery with the stethoscope is due to a backward flow of blood during diastole toward the heart. The diastolic murmur may be strikingly accentuated by pressing predominantly with the lower edge of the stethoscope bell, by immersing the arm in cold water, or by applying a cuff inflated to subdiastolic pressure to the limb below the site of auscultation.

Blumgart and Ernstene 1933

Associated Persons

• Paul Louis Duroziez (1826-1897)
• Herrman Ludwig Blumgart (1895-1977)
• Arthur Carlton Ernstene (1901-1971)

Alternative names

• Blumgart-Ernstene method

References

• Blumgart HL, Ernstene AC. Two mechanisms in production of Duroziez’s sign: Their diagnostic significance and clinical test for differentiating between them. JAMA. 1933; 100(3): 173-177.
• Zhang G. Eponyms in Aortic Regurgitation. LITFL 2019