Aortic Area Murmur
[2nd Intercostal space on the right]
Crescendo-decrescendo murmur [may
vary depending on the degree of stenosis].
Associated with delayed peaking
and upstroke of the carotid pulses [pulsus “Parvus et Tardus"].
This may not necessarily hold true
for the elderly.
Decreases in intensity with a Valsalva
Increases in intensity with squatting.
Radiates to the carotids.
May radiate to the mitral area -
phenomenon); this may especially hold true in the
elderly: in this setting, the murmur may be mistaken for mitral regurgitation.
As stenosis worsens, peak of the
murmur becomes later in systole and murmur invades A2 of the second
heart sound; 2nd sound may become paradoxically
The aortic valve may become fixed
in a narrowly opened position producing both aortic stenosis and aortic
Causes largely are calcific [majority
of cases], rheumatic deformity and or congenital abnormality of the
valve [seen in the young <than age 30].
Has a male predominance 4:1 and
occurs in 1-2 % of the population.