Auscultation of the heart in patients with aortic stenosis is critical to aid in the diagnosis of the disease. As the blood is ejected from the narrowed aortic valve during systole, it is possible to hear a distinct murmur. The typical murmur of aortic stenosis is described as a high-pitched, “diamond-shaped” crescendo-decrescendo, mid-systolic murmur. The ideal location to listen to this murmur is near the right sternal border, second intercostal space. The murmur may radiate into the neck and carotid arteries.
In mild aortic stenosis, the murmur peaks in early systole. However, as the disease progresses the peak moves to later in systole as a longer time is required to complete LV systole, and aortic valve closure is delayed. The intensity of the murmur typically increases as disease progresses; however, when heart failure develops and cardiac output declines, the murmur often becomes softer. Thus, the intensity of the murmur is not a good indicator of disease severity.
(To hear the heart sounds clearly, we recommend using your headphones)
Image 1: A murmur of Aortic Stenosis1
Pictured below is the ideal location to hear typical aortic stenosis murmur. Right sternal border, second intercostal space2.