From the Research
A delayed pulse in aortic stenosis occurs due to the narrowed aortic valve creating resistance to blood flow, resulting in a slower rise in pressure within the arterial system during systole, often described as "parvus et tardus" (small and late) 1. The pathophysiology of aortic stenosis involves the obstruction of blood flow from the left ventricle into the aorta, causing the left ventricle to generate higher pressures to overcome the stenotic valve 2. This pressure is transmitted more gradually to the peripheral circulation, resulting in a pulse that is diminished in amplitude and delayed in timing. The severity of the pulse delay typically correlates with the degree of valve stenosis, and this finding can be detected during physical examination by palpating peripheral pulses, particularly the carotid artery, where you may notice a slow upstroke and decreased amplitude 3. Some studies suggest that early intervention, such as transcatheter aortic valve replacement, may be beneficial in reducing the risk of major adverse cardiovascular events in patients with asymptomatic severe aortic stenosis 1. However, the management of asymptomatic severe aortic stenosis poses a clinical challenge, and guidelines diverge on other high-risk features warranting intervention 1. The role of renin-angiotensin system blockade in patients with aortic stenosis is also being explored, with emerging data suggesting potential benefits in slowing the progression of aortic valve calcification and left ventricular mass, as well as survival benefits 4. Key points to consider in the management of aortic stenosis include:
- The degree of valve stenosis and its impact on blood flow and pressure
- The presence of symptoms, such as chest pain, shortness of breath, or syncope
- The results of physical examination, including the detection of a delayed pulse
- The role of early intervention, such as transcatheter aortic valve replacement, in reducing the risk of major adverse cardiovascular events
- The potential benefits of renin-angiotensin system blockade in patients with aortic stenosis.