The Straight Back Syndrome Ejection Murmur

1. What is meant by the straight back syndrome?

ANS: Compression of the heart due to loss of the normal dorsal curvature of the spine, resulting in a pulmonary ejection murmur that is usually mistaken for that of either PS or ASD.

2. Why will loss of the normally gentle dorsal kyphosis cause a pulmonary ejection murmur?

ANS: The upper mediastinal structures, including the pulmonary artery, may be compressed against the sternum, and can actually produce a gradient of 5-15 mmHg across the pulmonary outflow tract.

Note: An anteroposterior chest diameter (back of sternum to front of vertebrae) that is one-third or less of the transverse diameter (from the inside of the ribs), measured at just above the right dome of the diaphragm, is almost diagnostic of the straight back syndrome.

If this patient with a loss of dorsal curvature, the anteroposterior diameter of the internal aspect of the chest (from back of sternum to front of vertebrae) is one-third of the transverse diameter. (Courtesy of Dr. Antonio C. deLeon, Jr.).

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