Diagnostic auscultatory complex in coarctation of the aorta.

In spite of numerous descriptions of the auscultatory and phonocardiographic findings in "adult" coarctation of the aorta (Reifenstein, Levine, and Gross, 1947; Wells, Rappaport, and Sprague, 1949; Brown et al., 1959; Cleland et al., 1956; Wood, 1956; Spencer, Johnston, and Meredith, 1958; Gasul, Arcilla, and Lev, 1966), no specific diagnostic auscultatory pattern has been outlined. The general conclusion has been that "auscultation is relatively unimportant in establishing the diagnosis of coarctation . .. " (Gardiner, 1959). The purpose of this report is to draw attention to an auscultatory complex which appears diagnostic of coarctation. This consists of the combination of an early systolic ejection sound (click) with a midlate systolic murmur (Fig. A-D) audible at the lower left sternal border and the apex. These two auscultatory signs have been noted before in coarctation but the diagnostic specificity of their association has not been recognized. The ejection click (Leatham and Vogelpoel, 1954; Cleland et al., 1956; Wood, 1956; Gasul et al., 1966; Hancock, 1966) may be immediately followed by an ejection systolic murmur ofvarying length. In other cases, however, it is followed, after a gap of at least 0-04 sec., by a mid-late systolic murmur. Such a murmur (Reifenstein et al., 1947; Wells et al., 1949; Wood, 1956; Spencer et al., 1958; Segal and Likoff, 1964; Gasul et al., 1966) is produced by flow either through collateral vessels or through the constricted segment of the aorta, and its delayed onset is due to the time taken for propagation of the pulse wave along the arterial system. The association of an early systolic click with a delayed systolic murmur is not encountered in any