Aortic Stenosis

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 maneuver.
  • Increases in intensity with squatting.
  • Radiates to the carotids.
  • May radiate to the mitral area - (Gallavardin 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 split.
  • The aortic valve may become fixed in a narrowly opened position producing both aortic stenosis and aortic regurgitation.
  • 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.