One man, aged 62, got a sudden syncope when playing with his grandchildren. In the past 6 months, he suffered from shortness of breath and chest pain after vigorous exercise. Heart examination indicates a soft second heart sound (S2), along with systolic ejection murmur, featuring a conduction to the carotid artery.
Which of the following picture is most likely to represent the patient's arterial pressure curve?
The answer is picture A.
Exertional dyspnea, angina, and syncope in this patient are nonspecific symptoms of many heart diseases. However, the conduction of systolic ejection murmur into the carotid artery is typical in aortic stenosis. During systole, blood exits from the left ventricle and turbulently flows through the narrow aortic valve, finally giving rise to the murmur. Besides, the soft S2 further supports the diagnosis of aortic stenosis, and the delay of A2 (the sound of the aortic valve closure) is likely to disappear as the condition progresses.
Aortic stenosis results from thickening or calcification of aortic valve, leading to LVOTO (left ventricular outflow tract obstruction). Therefore, each time the blood flows from the left ventricle to the aorta decreases. The reduction in stroke volume in turn makes a reduction in systolic pressure, but the diastolic pressure is normal. As a result, pulse pressure decreases. The blood pressure shown in Picture A is 110/80 mmHg, which is exactly this case.
However, the curve of systemic arterial pressure does not show the patient's systolic murmur, because this murmur comes from a turbulent flow of blood through the pathological aortic valve.
In conclusion, aortic stenosis causes decreased systolic blood pressure and pulse pressure. Patients may experience dyspnea on exertion or angina and the typical manifestation of systolic jet murmurs conducting into the carotid artery.