From the Guidelines
The murmur in aortic stenosis is typically late-peaking systolic.
Characteristics of the Murmur
- The murmur is usually loud (grade 4/6) and radiates to the carotids 1
- It is a systolic ejection murmur that occurs when blood is ejected across the aortic outflow tract 1
- The murmur starts shortly after S1, when the ventricular pressure rises sufficiently to open the semilunar valve, and peaks late in systole 1
Clinical Significance
- The presence of a late-peaking systolic murmur, along with a single or paradoxically split second heart sound (S2) and a delayed and diminished carotid upstroke, confirms the presence of severe AS 1
- However, in the elderly, the carotid upstroke may be normal due to the effects of aging on the vasculature, and the murmur may be soft or radiate to the apex 1
- Echocardiography is recommended for the diagnosis and assessment of AS severity, as physical examination findings are specific but not sensitive for the diagnosis of AS severity 1
From the Research
Timing of Murmur in Aortic Stenosis
- The timing of the murmur in aortic stenosis is typically late systolic, as indicated by studies 2, 3.
- Prolonged duration and late peaking of an aortic systolic ejection murmur are characteristics that best differentiate severe aortic stenosis from mild aortic stenosis on physical examination 2, 3.
- In contrast, systolic ejection murmurs of the left heart usually have their peak during early to mid-systole, as noted in a study on the clinical significance of the apical late systolic ejection murmur 4.
- Another study on the assessment of severity of aortic stenosis through time-frequency analysis of murmur does not specifically address the timing of the murmur in aortic stenosis 5.
- A study on the etiology and diagnosis of systolic murmurs in adults provides insights into the origin of systolic murmurs but does not specifically discuss the timing of the murmur in aortic stenosis 6.