BASAL SYSTOLIC MURMURS AND THE CAROTID PULSE CURVE IN THE DIAGNOSIS OF

W E have reviewed the last 30 autopsies at the University Hospital in which the diagnosis of calcareous aortic stenosis was made by the pathologist. Somewhat to our surprise we found that the clinical diagnosis had been missed in 65 % of the cases, although we should have expected this from the literature lf 2 ' 3 and our own studies. The literature reveals many opinions concerning calcareous aortic stenosis. For instance, the etiology has been variously ascribed to a primary degenerative arteriosclerotic lesion,4*5 to rheumatic fever,2'6'7 to congenital anomalies 8 and to hypercholesterolemia.9'10 The typical case presents a history of a systolic murmur known for many years, during which the patient is asymptomatic. This is followed by a period of increasing, variable symptomatology, including fatigue, sweating, dyspnea, orthopnea, chest pain, dizziness and syncope. Death is usually sudden, or due to congestive heart failure with or without acute or subacute bacterial endocarditis. Moreover, once the disease becomes symptomatic