Severe Aortic Stenosis Lesson

patient thorax when auscultating by stethoscope

patient position during auscultation
The patient was sitting during auscultation.

Description

In severe aortic stenosis, there is a diamond-shaped systolic murmur continuing through systole. The murmur is loud and higher pitched than a mild aortic stenosis murmur.

S1 is normal. S2 is louder than normal. In fact, you are hearing only the accentuated pulmonic component of S2 due to heart failure on the left side. The aortic ejection click heard in mild cases of valvular aortic stenosis is gone. A fourth heart sound can often be heard in late diastole. This is caused by the increased left ventricular wall thickness and stiffness.

Calcification of the aortic valve leaflets is a cause of this murmur. When viewing the cardiac animation, look for a greatly thickened left ventricular wall and the almost totally immobile aortic leaflets.

Phonocardiogram

Anatomy

Severe Aortic Stenosis


Authors and Sources

Authors and Reviewers

Sources

  • Heart and Lung Sounds Reference Library Diane S. Wrigley
    Publisher: PESI
  • Impact Patient Care: Key Physical Assessment Strategies and the Underlying Pathophysiology
    Diane S Wrigley & Rosale Lobo
  • Practical Clinical Skills: Lung Sounds
  • PESI Faculty - Diane S Wrigley
  • Case Profiles in Respiratory Care 3rd Ed, 2019
    William A.French
    Published by Delmar Cengage
  • Essential Lung Sounds by William A. French
    Published by Cengage Learning, 2011
  • Understanding Lung Sounds Steven Lehrer, MD
  • Clinical Heart Disease W Proctor Harvey, MD
    Clinical Heart Disease
    Laennec Publishing; 1st edition (January 1, 2009)
  • Heart and Lung Sounds Reference Guide
    PracticalClinicalSkills.com




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