From the Guidelines
When performing heart auscultation on a patient with an aortic valve replacement, focus on the aortic area and listen for a crisp, high-pitched closing sound, which is normal for prosthetic valves, especially mechanical ones. This sound may be louder than native valve sounds and can often be heard throughout the precordium. For bioprosthetic valves, the sounds may be softer but should still be clearly audible 1.
Key Findings
- A systolic murmur may suggest prosthetic valve stenosis or paravalvular leak
- A diastolic murmur could indicate prosthetic valve regurgitation
- The absence of the expected prosthetic valve sounds should prompt further investigation, as it may suggest valve thrombosis or pannus formation
Auscultation Technique
- Use both the diaphragm and bell of the stethoscope
- Have the patient lean forward and exhale to accentuate aortic sounds
- Listen in different positions (supine, left lateral decubitus) and during different phases of respiration
- Be alert for any changes in the intensity or quality of valve sounds, as these could indicate thrombosis or structural valve deterioration
Comprehensive Cardiac Examination
- A thorough auscultation should be part of a comprehensive cardiac examination, including inspection, palpation, and correlation with the patient's symptoms and history
- Any concerning findings during auscultation should lead to further evaluation, potentially including echocardiography, as recommended by guidelines for the management of patients with valvular heart disease 1.
From the Research
Characteristic Findings on Physical Exam Heart Auscultation for Aortic Valve Replacement (AVR)
- There are no specific characteristic findings on physical exam heart auscultation for a patient with aortic valve replacement (AVR) mentioned in the provided studies 2, 3, 4, 5, 6.
- The studies primarily focus on the management, treatment, and complications of aortic valve replacement, as well as the use of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) 2, 3, 4, 5.
- The provided evidence does not directly address the physical exam findings for patients with AVR, but rather discusses various aspects of aortic valve disease, treatment options, and patient selection 3, 4, 5, 6.