In a similar manner, there may be a delay between the appearance of each pulse in the brachial artery (in the arm) and the radial artery (in the wrist). Auscultation
The first heart sound may be followed by a sharp ejection sound ("ejection click") best heard at the lower left sternal border and the apex, and, thus, appear to be "split". The ejection sound, caused by the impact of left ventricular outflow against the partially fused aortic valve leaflets, is more commonly associated with a mobile bicuspid aortic valve than an immobile calcified aortic valve. The intensity of this sound does not vary with respiration, which helps distinguish it from the ejection click produced by a stenotic pulmonary valve, which will diminish slightly in intensity during inspiration.An easily heard systolic, crescendo-decrescendo (i.e., ejection) murmur is heard loudest at the upper right sternal border, at the 2nd right intercostal space, and radiates to the carotid arteries bilaterally. The murmur increases with squatting and decreases with standing and isometric muscular contraction such as the Valsalva maneuver, which helps distinguish it from hypertrophic obstructive cardiomyopathy (HOCM). The murmur is louder during expiration but is also easily heard during inspiration. The more severe the degree of the stenosis, the later the peak occurs in the crescendo-decrescendo of the murmur.The second heart sound (A2) tends to become decreased and softer as the aortic stenosis becomes more severe. This is a result of the increasing calcification of the valve preventing it from "snapping" shut and producing a sharp, loud sound.
The prevalence is increasing with the aging population in North America and Europe.Risk factors known to influence disease progression of AS include factors similar to those of coronary artery disease such as hypertension, advanced age, being male, hyperlipidemia, diabetes mellitus, cigarette smoking, metabolic syndrome, and end-stage kidney disease. History
Aortic stenosis was first described by French physician Lazare Rivière in 1663. Research
People on bisphosphonates were found in a 2010 study to have less progression of aortic stenosis, and some regressed. This finding led to multiple trials, ongoing as of 2012. Subsequent research failed to confirm the initial positive result. References
External links
Aortic stenosis at Curlie
Bonow, Robert O.; Brown, Alan S.; Gillam, Linda D.; Kapadia, Samir R.; Kavinsky, Clifford J.; Lindman, Brian R.; Mack, Michael J.; Thourani, Vinod H. (October 2017). "ACC/AATS/AHA/ASE/EACTS/HVS/SCA/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for the Treatment of Patients With Severe Aortic Stenosis". Journal of the American College of Cardiology. 70 (20): 2566–2598. doi:10.1016/j.jacc.2017.09.018. PMID 29054308.