Severe Aortic Stenosis Lesson #706
The patient was sitting during auscultation.
Description
In severe aortic stenosis, a diamond-shaped systolic murmur is present throughout systole. This murmur is louder and higher-pitched than a mild aortic stenosis murmur. Calcification of the aortic valve leaflets produces this murmur.
A fourth heart sound occurs in late diastole, immediately before S1. Increased left ventricular wall thickness/stiffness produces this fourth heart sound.
S1 is normal, while S2 is louder than normal. Note that only an accentuated pulmonic component of S2 can be heard. This S2 abnormality is caused by left-side heart failure.
The aortic ejection click, heard in mild cases of valvular aortic stenosis, is not present.
Observe the significantly thickened left ventricular wall and the near-totally immobile aortic leaflets in the cardiac animation video.
Phonocardiogram
Anatomy
Severe Aortic Stenosis
Authors and Sources
Authors and Reviewers
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Heart sounds by Dr. Jonathan Keroes, MD and David Lieberman, Developer, Virtual Cardiac Patient.
- Lung sounds by Diane Wrigley, PA
- Respiratory cases: William French
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David Lieberman, Audio Engineering
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Heart sounds mentorship by W. Proctor Harvey, MD
- Special thanks for the medical mentorship of Dr. Raymond Murphy
- Reviewed by Dr. Barbara Erickson, PhD, RN, CCRN.
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Last Update: 11/10/2021
Sources
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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
- Essential Lung Sounds
Diane S. Wrigley, PA-C
Published by MedEdu LLC - PESI Faculty - Diane S Wrigley
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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
