Observations on Continuous Murmurs over Partially Obstructed Arteries:  An Explanation for the Continuous Murmur Found in the Aortic Arch Syndrome

In recent years the so-called aortic arch syndrome has received considerable attention and has been well reviewed by Ross and McKusick¹; Currier, DeJong, and Bole,² and Skipper and Flint.³ These authors and others have described the cerebral manifestations, ocular findings, ischemia and atrophy of the tissues of the face, hyperactivity of the carotid sinuses and syncope and epilepsy, and the vascular insufficiency of the upper extremities which is sometimes productive of intermittent claudication there. The etiology of the aortic arch syndrome, which has also been termed "pulseless disease," "reverse coarctation," and, in Japan, Takayasu's disease, has been ascribed to syphilitic aortitis and arteritis with or without aneurysm formation, atheromatosis, so-called giant-cell arteritis, chronic dissecting aneurysm, thrombophilia, and perhaps chest trauma.

One of the most puzzling features of the disorder has been the occurrence in at least eight reported cases of a loud continuous systolic and diastolic murmur