Page 126 - Clinical Pearls in Cardiology

114 Clinical Pearls in Cardiology

to as the 50/50 murmur, as it is present in 50% of persons
above 50 years of age). This murmur can simulate
obstructive aortic stenosis. Therefore, it is very important
to differentiate between the two entities (Table 2).
Table 2: Difference between aortic sclerosis and aortic
stenosis
Aortic sclerosis Aortic stenosis
Cardiac apex Normal Heaving
Carotid pulse Normal Slow or delayed upstroke
A2 Normal or loud Soft or absent
sometimes ‘paradoxical’
splitting
Murmur Short with early Long with late peaking
peaking

Aortic valve sclerosis eventually progresses to clinically
significant aortic stenosis in many patients within six
to ten years. Hence, aortic sclerosis is now the leading
indication for aortic valve replacement.
22. When will you clinically suspect co-existing aortic
regurgitation in a patient with dominant aortic
stenosis?
About two-thirds of patients with calcific aortic stenosis
have some degree of regurgitation. Sometimes both
stenosis and regurgitation co-exist in a balanced degree.
In balanced lesions, the clinical course and features
are usually that of aortic stenosis in isolation. The
clinical clue towards the presence of co-existing aortic
regurgitation is a high-pitched blowing decrescendo
early-diastolic murmur in the aortic area.
The blood pressure is also an important clinical clue in
persons with combined aortic regurgitation and stenosis.