Fast Five Quiz: Aortic Stenosis

Yasmine S. Ali, MD


June 25, 2019

The classic crescendo-decrescendo systolic murmur of aortic stenosis begins shortly after the first heart sound. The intensity increases toward midsystole and then decreases, and the murmur ends just before the second heart sound. It is generally a rough, low-pitched sound that is best heard at the second intercostal space in the right upper sternal border. It is harsh at the base and radiates to one or both carotid arteries.

S1 is usually normal or soft. The aortic component of the second heart sound, A2, is usually diminished or absent, because the aortic valve is calcified and immobile and/or the aortic ejection is prolonged and is obscured by the prolonged systolic ejection murmur. The presence of a normal or accentuated A2 speaks against the presence of severe aortic stenosis.

Angina pectoris in patients with aortic stenosis is typically precipitated by exertion and relieved by rest. Thus, it may resemble angina from coronary artery disease.

Patients may present with manifestations of infective endocarditis (ie, fever, fatigue, anorexia, back pain, and weight loss). The risk for infective endocarditis is higher in younger patients with mild valvular deformity than in older patients with degenerated calcified aortic valves. It can occur in patients of any age with hospital-acquired Staphylococcus aureus bacteremia.

Read more on the presentation of aortic stenosis.


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