From the Guidelines
Carotid Pulses in Aortic Stenosis
Carotid pulses are typically delayed and diminished in patients with severe aortic stenosis.
- The classic physical examination findings of severe aortic stenosis include a loud, late-peaking systolic murmur that radiates to the carotids, a single or paradoxically split second heart sound (S2), and a delayed and diminished carotid upstroke 1.
- However, in some cases, such as in the elderly, the carotid upstroke may be normal due to the effects of aging on the vasculature 1.
- A normally split second heart sound is the only physical examination finding that is reliable in excluding the possibility of severe aortic stenosis 1.
- Echocardiography is recommended for the diagnosis and assessment of aortic stenosis severity, and can help identify patients with severe aortic stenosis who may have a delayed and diminished carotid upstroke 1.
- The assessment of carotid pulses is an important part of the physical examination in patients with suspected aortic stenosis, and can help guide further evaluation and management 1.
- It's worth noting that, carotid pulses are not always a reliable indicator of aortic stenosis severity, and should be considered in conjunction with other physical examination findings and diagnostic tests, such as echocardiography 1.
From the Research
Carotid Pulses in Aortic Stenosis
- The relationship between carotid pulses and aortic stenosis has been studied in several research papers 2, 3, 4, 5, 6.
- In patients with aortic stenosis, the carotid pulse tracing may be affected, with a slower rate of rise and a longer initial upstroke time compared to normal controls 2.
- The severity of aortic stenosis cannot be predicted from the carotid pulse tracing alone, but it can be used to separate patients with aortic stenosis from those with normal subjects 2.
- Other noninvasive parameters, such as Doppler echocardiography, can provide more accurate assessments of the severity of aortic stenosis 3.
Characteristics of Carotid Pulses in Aortic Stenosis
- The carotid pulse in patients with aortic stenosis may have a prolonged initial upstroke time and a slower rate of rise 2, 4.
- The time to one-half carotid upstroke and carotid ejection time can be used to assess the severity of aortic stenosis, but with limited accuracy 3.
- An absent or weak carotid pulse may indicate critical aortic stenosis 5.
- Carotid artery stiffness, measured by echo-tracking, may be increased in patients with aortic stenosis, with higher augmentation index and lower arterial compliance 6.
Clinical Implications
- The assessment of carotid pulses can be a useful tool in the diagnosis and evaluation of aortic stenosis, particularly when used in combination with other noninvasive parameters 3, 4.
- A weak or impalpable carotid pulse in the presence of an aortic stenosis murmur may indicate critical aortic stenosis and warrants urgent investigation 5.
- Further research is needed to fully understand the relationship between carotid pulses and aortic stenosis, and to develop more accurate and reliable noninvasive methods for assessing the severity of aortic stenosis 2, 3, 6.