Aortic Stenosis

Aortic Stenosis

Aortic Stenosis is a condition whereby there is obstruction of blood flow across the aortic valve. The heart consists of different parts and aorta is part of it. This is the main artery that carries blood from the heart to other parts of the body. When a patient is diagnosed with aortic stenosis, it means that the valve does not open fully as expected. This therefore will lead to decreased flow of blood from the heart. This condition may begin from birth or develop at later years. The symptoms develop gradually. The patient may be asymptomatic for a period of ten to twenty years.  In examining the heart, a murmur of the heart can be noticed. This is a sound that generates from turbulent blood flow.  Murmur can be described in terms of location, intensity, timing and pitch. An analysis of a 74-year-old patient with aortic stenosis will be analyzed in this paper and the murmur described (Driscoll, Shaddy & Feltes, 2013).

This is an elderly person and it is essential to determine the location of the murmur. It is necessary to understand the location in which the murmur is heard well. One can use four listening posts on the chest in order to assess the murmur. There is the aortic valve post where the murmur can be best heard. This is the right upper sterna border. The other post is the pulmonic valve which is the left upper sterna border.  Another location to listen to murmur is the mitral valve post and lastly the Erb’s point. For aortic stenosis, the murmur is located at the aortic listening post and it radiates towards the neck. This sound can be heard from this location therefore a patient with aortic stenosis can be examined from this post (Lily, 2010).

The sound of the murmur for a patient with aortic stenosis can also be described in terms of intensity. The intensity of a murmur can be determined by the volume of the blood that flows through a defect and distance between the stethoscope and lesion. A patient who is thin and has severe stenosis with high pressure gradient will have a loud murmur. The intensity may be grouped into four grades.  Grade 1 intensity is one that is barely audible (Williams and Wilkins, 2009). Grade II is audible but quite soft. Grade III is easily audible and grade IV is loud. Intensity cannot determine if the aortic stenosis is severe. When the condition of aortic stenosis worsens, the left ventricular may begin to fail. This leads to a decline of the ejection fraction and sufficient force that create to turbulent flow is not produced.  This leads to the decrease in the intensity of the murmur. The patient is symptomatic and this may suggests that the aortic stenosis is severe. The intensity of the murmur may therefore be less intense.

Murmur can also be described in terms of timing. This is essential to accurate diagnosis.  A murmur can be classified into systolic, diastolic or can be continuous throughout systole and diastole. Systole occurs between the first and second heart sounds, and diastole occurs between the third and fourth heart sounds. Since the patient has aortic stenosis, the murmur will be systolic.  The pitch can also help describe the heart murmur (Tapol & Califf, 2007).

The pitch can be high or low depending on the pressure of the gradient across the lesion. When the pitch is high, there is large pressure of the gradient across the pathologic lesion. When the pitch is low, the pressure of the gradient is also low. Patients with aortic stenosis have a high pitched murmur. There is large pressure gradient which is between the left ventricular and the aorta. In the 74-year-old patient, it is evident that the murmur will be high pitched (Lily, 2010).

Patients with aortic stenosis murmur develop symptoms when the disease is advanced.  Diagnosis of the condition may take place when the health care provider hears a heart murmur which is followed by other tests. There are different symptoms of aortic stenosis murmur. The 74-year-old patient is experiencing these symptoms. Chest discomfort is one of the symptoms. The patient feels pain in the chest and it gets worse when performing an activity. This pain reaches into the arms, neck, and jaw. The patient feels that the chest is squeezed and tight.

Another symptom is coughing whereby the cough is accompanied by blood (American College of Physicians, 2008). This can be accompanied by breathing problems when exercising. The 74 year old patient may experience this even when walking long distances. This is like doing exercises and the patient may not even engage in tasks that uses a lot of energy. The patient also becomes tired very easily and would not engage in tasking activities.  It is also a common symptom of aortic stenosis patient to feel the heart beat. There are palpitations due to pressure of the pathologic lesions. The heart has pressure in transporting blood in the narrow valve that is as a result of aorta stenosis. In addition, the patient experiences fainting, weaknesses or dizziness when in any form of activity. This may be dangerous if the patient is living alone because fainting may occur any time.

References

American College of Physicians (2008). Medical Knowledge Self-assessment Program for

Students Four. Philadelphia:  ACP Press.

Driscoll D., Shaddy R., & Feltes T. (2013). Moss & Adams Heart Disease in Infants, Children

and Adolescents: Including the Fetus and Yound Adults. New York: Wolters Kluwer Health.

Lily L. (2010) Pathophysiology of Heart Disease. New York: Wolters Kluwer

Topol E. & Califf R. (2007). Textbook of Cardiovascular Medicine, Volume 355. New York:

Wolters Kluwer Health.

Williams L & Wilkins. (2009). Evaluating Heart and Breath Sounds. New York: Wolters

Kluwer Health.