Severe Aortic Stenosis Lesson #682

patient thorax when auscultating by stethoscope

patient position during auscultation
The patient was sitting during auscultation.


In severe aortic stenosis, there is a diamond-shaped systolic murmur continuing through systole. The murmur is loud and higher pitched than a mild aortic stenosis murmur.

S1 is normal. S2 is louder than normal. In fact, you are hearing only the accentuated pulmonic component of S2 due to heart failure on the left side. The aortic ejection click heard in mild cases of valvular aortic stenosis is gone. A fourth heart sound can often be heard in late diastole. This is caused by the increased left ventricular wall thickness and stiffness.

Calcification of the aortic valve leaflets is a cause of this murmur. When viewing the cardiac animation, look for a greatly thickened left ventricular wall and the almost totally immobile aortic leaflets.



Severe Aortic Stenosis

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