Aortic Stenosis Case #1 - Question #1 Answer

An 82-year-old previously healthy male presents with exertional dyspnea and lower extremity edema. Physical examination reveals a IV/VI systolic murmur at the right upper sternal border peaking late in systole with no audible S2 heart sound. The murmur radiates to the cardiac apex where it sounds holosystolic but does not increase with handgrip maneuvers. The carotid upstroke is weak and delayed. Echocardiography confirms the presence of aortic valve stenosis with a mean pressure gradient of 45 mm Hg and an aortic valve area of 0.8 cm2.

Which of the following is the degree of aortic stenosis present?

A. Mild

B. Moderate

C. Severe

D. Critical

 

Severe aortic stenosis occurs when the mean pressure gradient across the aortic valve is greater than 40 mm Hg and the aortic valve area is less than 1.0 cm2. Physical exam findings consistent with severe aortic stenosis include late peaking in systole of the murmur, a soft or absent S2 heart sound and pulsus parvus et tardus.