Aortic Stenosis
Look at the diagram below of the sound produced by aortic stenosis and then attempt the question.
1 |
Aortic stenosis is classically described as a(n)... |
AS is usually louder in higher areas of the chest (
as shown by the diagram from earlier)
Galavardin Dislocation
Occurs in adults with AS caused by fibro-calcific changes.
There is a noisy/impure murmur located in the 2nd right intercostal space, whereas there is a pure and frequently musical sound located over the Left Ventricular impulse {near axilla} which can be surprisingly loud.
First Described by Gallavardin in 1925
As AS progresses and worsens the loudest point of the murmur moves closer to S2 as the ventricle has to generate a higher pressure before it can force blood through the stenotic valve, so in the diagram at the top of this page it is neither early aortic stenosis or late.
AS is most easily heard if a patient is sitting up and exhales as this brings the heart closer to the chest wall.
Radiation of AS is important, AS radiates to the carotids and so can be heard there as well as in the right clavicle (here simply rest the stethoscope on the clavicle to check for murmurs). Note that carotid bruits can occur as well and mask the sounds of AS or masquerade as AS!
As you may have guessed AS can be confused with some of the benign murmurs previously mentioned, which is why it is important to rule out any other factors before AS is considered. The high volume ejection murmurs mentioned however will go away once the demand on the heart is reduced.
Aortic Stenosis
A systolic crescendo-decrescendo murmur with radiation to the carotids, accentuated if a patient sits up and breathes out
The following are two examples of AS one is an early case of AS and the second a more severe case of AS
Mild AS
Severe AS
