Aortic Stenosis
This murmur is systolic, crescendo-decrescendo in shape, harsh in quality, located in the sash distribution (clavicle to apex), and radiates to clavicle or neck. Causes are usually calcification in older patients (age > 50) and congenital bicuspid valve in younger patients (age < 50).
Patient 1:
This is an older man who was admitted to the hospital with a pathologic C6 fracture and was found to have severe aortic stenosis. Echocardiogram showed an aortic valve area of 0.8 cm2. The murmur peaks late in systole. Also note that over the apex, the murmur takes on a musical quality (Gallavardin phenomenon).
Aortic Stenosis
Annotated
Aortic Stenosis
Annotated
Patient 2:
This is an older man who was admitted to the hospital with progressive symptoms related to severe bioprosthetic aortic valve stenosis. He underwent transcutaneous aortic valve replacement (TAVR). Note that the intensity of the murmur increases after a pause.
Aortic Stenosis
Annotated
Aortic Stenosis
Annotated
Patient 3:
This is an older woman who was admitted to the hospital for an acute traumatic hip fracture, and was found to have mild aortic stenosis. Note that the murmur peaks early in systole.
Aortic Stenosis
Annotated
Patient 4:
This patient has severe aortic stenosis.
Aortic Stenosis
Annotated
Patient 5:
This patient has severe aortic stenosis.
Aortic Stenosis
Annotated
Patient 6:
This patient has severe aortic stenosis.
Aortic Stenosis
Patient 7:
This is an older woman with moderate aortic stenosis. The first recording was taken over the right clavicle. The second recording was taken over the apex.
Aortic Stenosis
Annotated
Aortic Stenosis
Annotated
Aortic Stenosis
Annotated
Patient 8:
This is an older man with multiple valvulopathies, including severe mitral valve regurgitation, moderate aortic stenosis, and moderate pulmonic insufficiency.
I got a quick question about S1, i’ve noticed that on a lot of the recordings of aortic stenosis and aortic regurgitation the S1 is really silent or even absent so that you can only hear the murmur and the S2 .The S2 is usually also really loud,why would that be so?
TF, great observation.
In the case of aortic stenosis, I think there are at least two things that contribute to this. First, most often AS is recorded over the base of the heart where S1 will be distant. Second, the murmur of AS tends to be loud and harsh and there is an acoustic phenomenon whereby quieter sounds become more difficult (and in some cases impossible) to appreciate when they occur right next to a louder sound (they get “drowned”). In some of the examples on this page above (e.g. patient #1), you can clearly see an S1 on the phono strip but cannot hear it.
In the case of aortic insufficiency, typically the sound is recorded over Erb’s point (3rd/4th intercostal space along L sternal border) so S1 should be more appreciable. And indeed it is, at least in some of our recordings (see patient #3: https://physicaldiagnosispdx.com/cardiology-multimedia-new/aortic-regurgitation-2/).
Hope this helps.
Thank you once again Sir!