From the Guidelines
Aortic stenosis is typically characterized by a systolic ejection murmur, which is a harsh, crescendo-decrescendo sound best heard at the right upper sternal border and often radiates to the carotid arteries. This murmur occurs during systole due to turbulent blood flow caused by the narrowed aortic valve. The severity of aortic stenosis generally correlates with the intensity of the murmur, although in very severe stenosis with reduced cardiac output, the murmur may become quieter 1.
Key Characteristics of the Murmur
- The murmur is typically described as a harsh, crescendo-decrescendo (diamond-shaped) sound
- Best heard at the right upper sternal border (second intercostal space)
- Often radiates to the carotid arteries
- Occurs during systole due to turbulent blood flow through the narrowed aortic valve
Clinical Findings and Diagnosis
The diagnosis of aortic stenosis is often suspected based on the finding of a systolic ejection murmur on cardiac auscultation, but physical examination findings are specific but not sensitive for the diagnosis of AS severity 1. Echocardiography is recommended for the diagnosis and assessment of AS severity, including the evaluation of valve anatomy and function, and determining the LV response to pressure overload 1.
Importance of Echocardiography
- Echocardiography is indicated when there is a systolic murmur that is grade 3/6 or greater, a single S2, or symptoms that might be due to AS
- Doppler echocardiographic measurements of maximum jet velocity, mean transvalvular pressure gradient, and continuity equation valve area can define the severity of the stenotic lesion
- Echocardiography is also used to assess LV size and function, degree of hypertrophy, and presence of other associated valvular disease 1
From the Research
Aortic Stenosis and Systolic Murmur
- Aortic stenosis (AS) is a valvular pathology that can be accompanied by an ejection systolic murmur, as well as symptoms such as dyspnoea, chest pain, or syncope 2
- The presence of a systolic murmur in patients with AS can be an important indicator of the disease's severity and the need for further evaluation and potential treatment
- Echocardiography is a crucial diagnostic tool for assessing the severity of AS and determining the need for valve replacement, as it allows for the evaluation of valve gradients and left ventricular function 2
Relevance of Studies
- The study published in the Australian journal of general practice in 2024 provides relevant information on the management and diagnosis of aortic stenosis, including the association with systolic murmur 2
- The study published in Cancer letters in 1979 is not relevant to the question of aortic stenosis and systolic murmur, as it discusses the metabolism and DNA binding of polycyclic aromatic hydrocarbons 3