Aortic Stenosis

Aortic Area Murmur
[2nd Intercostal space on the right]
Systolic

• Crescendo-decrescendo murmur [may vary depending on the degree of stenosis].
• Associated with delayed peaking and upstroke of the carotid pulses [pulsus “Parvus et Tardus"].
• This may not necessarily hold true for the elderly.
• Decreases in intensity with a Valsalva maneuver.
• Increases in intensity with squatting.
• Radiates to the carotids.
• May radiate to the mitral area - (Gallavardin phenomenon); this may especially hold true in the elderly: in this setting, the murmur may be mistaken for mitral regurgitation.
• As stenosis worsens, peak of the murmur becomes later in systole and murmur invades A2 of the second heart sound; 2nd sound may become paradoxically split.
• The aortic valve may become fixed in a narrowly opened position producing both aortic stenosis and aortic regurgitation.
• Causes largely are calcific [majority of cases], rheumatic deformity and or congenital abnormality of the valve [seen in the young <than age 30].
• Has a male predominance 4:1 and occurs in 1-2 % of the population.