First heart sound in AS
S1 is
normal or decreased intensity.
It is due to partial closure of mitral valve in
presystole. Lound S1 is associated with MS.
A2 in AS
Loud A2
indicate pliable valve cusp in congenital AS.
Soft A2 –
Occur due to rigid calcific valve.
Comment on split in
AS
Split may
be normal.
Paradoxical split or single S2 can occur.
When will you get
normal split in AS
Occur in
mild to moderate AS.
Split is
normal even in congenital MS.
What is the
significance of paradoxic split in AS
Paradoxic
split indicate severe AS if there no left bundles branch block (LLBB) . LV dysfunction seen in only 25% of elderly
with severe AS.
Paradoxical
split is due to prolonged electromechanical systole which produce delay in A2
component.
What is the
significance of single S2 in AS
Seen in 66% of
elderly with severe AS. It is due to absent A2 or due to masked P2 by the
murmur.
Significance of S4
inAS
It
indicate severe AS in the absence of coronary artery disease or hypertension. Palpable
S4 always indicate severe AS.
Aortic ejection
click
1.
AEC
indicate valvular AS with mobile valves.
2.
AEC
is common in congenital AS, and bicuspid aortic valve.
3.
It
is rare in elderly.
4.
It
disappear with valve calcification.
5.
AEC
does not correlate with severity of AS.
6.
Amplitude
correlate with that of A2.
What are the
features of AEC
1.
AEC occur after S1.
2. It is best heard at the apex/ aortic area.
3.
There
is no variation with respiration.
4.
It
is a high pitched sound.
What is AEC
It is a
high pitched sound produced due to the snapping open of the stenotic thickened
aortic valve.
Significance of
aortic ejection click
1.
It
indicate that the stenosis is at valvular level.
2.
The
severity of AS is mild.
