Aortic sclerosis physical examination: Difference between revisions

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==Overview==
==Overview==
Aortic sclerosis commonly affects elderly population. Microscopic changes reveal lipoprotein accumulation, cellular infiltration and extracellular matrix formation that cause progressive thickening of the aortic valve.<ref name="pmid15967862">{{cite journal |author=Freeman RV, Otto CM |title=Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies |journal=[[Circulation]] |volume=111 |issue=24 |pages=3316–26 |year=2005 |month=June |pmid=15967862 |doi=10.1161/CIRCULATIONAHA.104.486738 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15967862 |accessdate=2012-04-10}}</ref>
While a short mid-systolic murmur may be heard in aortic sclerosis, there is no fusion of the commisures and no significant obstruction to forward flow across the aortic valve. As a result, the [[S2]] is normal in aortic sclerosis and the carotid upstroke is normal (i.e. [[pulsus parvus et tardus]]) is absent.
 
Aortic sclerosis is defined based on [[transthoracic echocardiography|transthoracic echocardiographic]] findings which include irregular leaflet thickening and focal valve thickening with associated increase in echogenicity.<ref name="pmid15967862">{{cite journal |author=Freeman RV, Otto CM |title=Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies |journal=[[Circulation]] |volume=111 |issue=24 |pages=3316–26 |year=2005 |month=June |pmid=15967862 |doi=10.1161/CIRCULATIONAHA.104.486738 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15967862 |accessdate=2012-04-10}}</ref><ref name="pmid10403851">{{cite journal |author=Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS |title=Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly |journal=[[The New England Journal of Medicine]] |volume=341 |issue=3 |pages=142–7 |year=1999 |month=July |pmid=10403851 |doi=10.1056/NEJM199907153410302 |url=http://dx.doi.org/10.1056/NEJM199907153410302 |accessdate=2012-04-10}}</ref><ref name="pmid9060903">{{cite journal |author=Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM |title=Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study |journal=[[Journal of the American College of Cardiology]] |volume=29 |issue=3 |pages=630–4 |year=1997 |month=March |pmid=9060903 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109796005633 |accessdate=2012-04-10}}</ref><ref name="pmid21295189">{{cite journal |author=Gharacholou SM, Karon BL, Shub C, Pellikka PA |title=Aortic valve sclerosis and clinical outcomes: moving toward a definition |journal=[[The American Journal of Medicine]] |volume=124 |issue=2 |pages=103–10 |year=2011 |month=February |pmid=21295189 |doi=10.1016/j.amjmed.2010.10.012 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(10)00913-7 |accessdate=2012-04-10}}</ref>
 
Aortic sclerosis is generally an asymptomatic condition and usually detected as an incidental finding on [[transthoracic echocardiography]]. Therefore, physical examination is neither sensitive nor specific for diagnosing aortic sclerosis.
 
==Physical Examination==
==Physical Examination==
* Normal S2
* Normal [[S2]]
* [[Heart murmur#Systolic Heart Murmurs|Systolic murmur]]
* [[Heart murmur#Systolic Heart Murmurs|Systolic murmur]]
:*Short mid-systolic murmur
:*Short mid-systolic murmur
:*Best heard at right second intercostal space
:*Best heard at right second intercostal space
 
*Absence of bilateral radiation to the [[carotid arteries]] and normal [[S2]] helps to differentiate aortic sclerosis murmur from [[Aortic stenosis physical examination#Heart|aortic stenosis murmur]]
*Absence of bilateral radiation to the carotid arteries and normal S2 helps to differentiate aortic sclerosis murmur from [[Aortic stenosis physical examination#Heart|aortic stenosis murmur]]


==References==
==References==
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[[CME Category::Cardiology]]


[[Category:Disease]]
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Cardiology]]

Latest revision as of 23:04, 14 March 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

While a short mid-systolic murmur may be heard in aortic sclerosis, there is no fusion of the commisures and no significant obstruction to forward flow across the aortic valve. As a result, the S2 is normal in aortic sclerosis and the carotid upstroke is normal (i.e. pulsus parvus et tardus) is absent.

Physical Examination

  • Short mid-systolic murmur
  • Best heard at right second intercostal space

References

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