Heart Sounds Research Lab
Aortic Valve Stenosis
The Heart Sounds and Murmurs Laboratory | 6560 Fannin St, Suite 1836| Houston, Texas 77030 | 832-355-2937
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During aortic valve stenosis the narrowing of the aortic valve requires a marked increase in systolic pressure within the left
ventricle to drive blood through the stenotic valve orifice. When the stenosis is severe, the aortic pulse curve is classically
deformed: the aortic pressure pulse is narrow and there is a slow rise during systole with notching on the upstroke, the
dicrotic notch. This pulse is referred to as pulsus parvus (small) and tardus (slow).
The pressure difference between the left ventricle and the central aorta during ejection is a direct consequence of aortic valve
narrowing. This gradient is small at the beginning of ejection, rises to a peak, and then falls in late ejection. The murmur of
aortic stenosis is the auscultatory concomitant of this gradient and reflects the noise heard because of the turbulence of high
velocity flow through the stenosed valve. Accordingly, the murmur will have a diamond or kite shape and is referred to as a
crescendo-decrescendo murmur. The murmur is harsh and rough, and is frequently accompanied by a thrill. This murmur is
best heard on the right side, over the second intercostal space.