Moderate Si A2
Aortic Valve Stenosis a2
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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