Moderate Si A2



Si a2

Aortic Valve Stenosis a2

p2 I

LTsually a normal valve anulus with fusion of some or most of the valve leaflets, restricting flow across the valve

LTsually a bicuspid valve with progressive obstruction, but there may be a dysplastic valve or damage from rheumatic fever or degenerative disease.

Location. LTpper left sternal border

Radiation. In mild degrees of stenosis, the murmur may be heard over the course of the pulmonary arteries in the lung fields.

Intensity. Increases in intensity and duration as the degree of obstruction increases

Qitality. Ejection, peaking later in systole as the obstruction increases

Location. Midsternum, upper right sternal border

Radiation. To the carotid arteries and suprasternal notch; may also be a thrill

Intensity. Varies, louder with increasingly severe obstruction

Qitality. An ejection, often harsh, systolic murmur

LTsually a prominent ejection click in early systole

The pulmonary component of the second sounds at the base (P2) becomes delayed and softer, disappearing as obstruction increases. Inspiration may increase the murmur and expiration may increase the click.

Growth is usually normal.

Newborns with severe stenosis may be cyanotic from right-to-left shunting at atrial level and rapidly develop congestive heart failure.

May be an associated ejection click

The aortic closure sound may be increased in intensity. There may be a diastolic murmur of aortic valve regurgitation. Children and adolescents are seldom symptomatic, but newborns with severe stenosis may have weak or absent pulses and severe congestive heart failure. LTnless heart failure, growth is normal. May not be audible until adulthood even though the valve is congenitally abnormal

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