Aortic stenosis vs Aortic regurgitation
How to tell Aortic stenosis and Aortic regurgitation apart when a board question makes them look alike.
AS is systolic obstruction with carotid radiation; AR is diastolic leak with wide pulse pressure.
Side by side
Harsh crescendo-decrescendo systolic murmur at the right upper sternal border radiating to carotids with weak delayed pulse.
Early diastolic decrescendo murmur with wide pulse pressure, bounding pulses, and LV volume overload.
Outflow obstruction from a narrowed aortic valve creates pressure overload and concentric LV hypertrophy.
Diastolic backflow from aorta to LV creates volume overload and widened systolic-diastolic pressure difference.
Pulsus parvus et tardus, syncope/angina/dyspnea, and carotid radiation point aortic stenosis.
Water-hammer pulse, head bobbing, wide pulse pressure, and early diastolic timing point aortic regurgitation.
The trap
Both can cause LV hypertrophy and heart failure symptoms, so murmur timing and pulse pressure decide.
Watch it explained
The repair move
For aortic valve stems, name timing first: systole means stenosis, diastole means regurgitation.
Try a free question
CoreAn older patient has exertional syncope, angina, dyspnea, a harsh crescendo-decrescendo systolic murmur at the right upper sternal border, and radiation to the carotids. Which lesion is most likely?
Show answer and explanation
Answer: A. Aortic stenosis. Aortic stenosis causes a systolic ejection murmur radiating to the carotids with pulsus parvus et tardus and exertional symptoms.
Why the other choices are tempting
- B. Aortic regurgitation is an early diastolic decrescendo murmur with wide pulse pressure.
- C. Mitral regurgitation is holosystolic at the apex with axillary radiation.
- D. Hypertrophic cardiomyopathy can cause systolic murmur but is louder with Valsalva and usually lacks carotid radiation/pulsus parvus et tardus.
- E. Pulmonic regurgitation is an early diastolic murmur at the left upper sternal border.
Flashcards
Tap a card to flip it.
What is the fastest separator for Aortic stenosis vs Aortic regurgitation?
AS is systolic obstruction with carotid radiation; AR is diastolic leak with wide pulse pressure.
What clue should make you choose Aortic stenosis?
Harsh crescendo-decrescendo systolic murmur at the right upper sternal border radiating to carotids with weak delayed pulse.
Quick answers
What is the fastest way to tell Aortic stenosis from Aortic regurgitation?
AS is systolic obstruction with carotid radiation; AR is diastolic leak with wide pulse pressure.
What is the key clue for Aortic stenosis?
Harsh crescendo-decrescendo systolic murmur at the right upper sternal border radiating to carotids with weak delayed pulse.
What is the key clue for Aortic regurgitation?
Early diastolic decrescendo murmur with wide pulse pressure, bounding pulses, and LV volume overload.
What is the common trap with Aortic stenosis vs Aortic regurgitation?
Both can cause LV hypertrophy and heart failure symptoms, so murmur timing and pulse pressure decide.