Abstract
Twenty-two cases with renovascular hypertension were studied to assess the diagnostic value as well as the limitation of abdominal murmurs. Control group which has no stenotic lesion in arteriography showed the abdominal murmur in 34 out of 48 cases, but the murmur was localized over the pulsated abdominal aorta and characterized by the low to medium pitch and short decrescendo following aortic distension sound ("accidental" murmur). The murmur was intensified by amyl nitrite inhalation or by isoproterenol administration, and abolished by methoxamine. The abdominal murmur of renovascular hypertension, on the contrary, had the maximum audibility over the affected artery and high-pitched and long continued in character (occupied all systole, transsystolic or continuous) ("organic" murmur). The intensity of the murmur is not differential clue between these 2 murmurs. The murmur of renal artery stenosis with significant hypertension was attenuated by amyl nitrite inhalation. Overall diagnostic accuracy of renovascular hypertension by phonoarteriography was only 64%, and the limitation of simple auscultation and also of phonoarteriography was demonstrated and the reason was discussed. Despite of the limitation, the phonoarteriography had the merit to discriminate the accidental murmur from the organic murmur and to evaluate the post-operative cases. Because of the definite association of the organic murmur and the stenosis of either the aorta or the main branch, it was concluded that the presence of the "organic" murmur is absolutely indicative of aortography and selective arteriography.
