Aortic Stenosis and Its Characteristic Pulse Features

Aortic stenosis is a condition that significantly affects the heart's ability to pump blood efficiently through the aortic valve. One of the most notable physical signs in patients with this condition is the presence of a strong, crescendo-decrescendo systolic murmur. This murmur is typically heard during cardiac auscultation and often radiates to the neck or the suprasternal notch. The intensity of the murmur generally correlates with the severity of the stenosis — the more severe the narrowing, the louder the murmur.

Key Clinical Signs and Symptoms

In addition to the characteristic heart murmur, patients may exhibit specific pulse abnormalities. When measuring blood pressure, a narrow pulse pressure is commonly observed, often ranging between 10 to 20 mmHg. This reduced pulse pressure reflects the diminished stroke volume due to the restricted blood flow through the narrowed aortic valve.

It is also important to note that in some cases — particularly when aortic stenosis is accompanied by heart failure — the symptoms may be less pronounced. In these situations, the expected intensity of the murmur might be reduced due to decreased cardiac output, making clinical assessment more complex and requiring further diagnostic evaluation.

Causes and Risk Factors

Congenital and Acquired Causes

Aortic stenosis can arise from both congenital and acquired factors. Congenital causes often involve a bicuspid aortic valve, which is present from birth and can lead to early-onset stenosis. Acquired forms of the disease include rheumatic heart disease, which is typically the result of untreated streptococcal infections leading to valve damage.

Age-Related Degenerative Changes

In older adults, degenerative calcification of the aortic valve is a common cause of stenosis. This process involves the progressive buildup of calcium deposits on the valve leaflets, leading to stiffness and reduced valve mobility. As the population ages, this form of aortic stenosis is becoming increasingly prevalent and is now the most common cause in elderly patients.