Aortic stenosis produces a diamond-shaped systolic murmur best heard at the aortic area. The murmur is usually transmitted to one or both carotid arteries. It decreases in intensity with the Valsalva maneuver, handgrip, and sudden squatting, and increases with passive leg raising. In moderate or severe stenosis, A2 is diminished or absent due to slow filling. The carotid pulses may be diminished and delayed (pulsus parvus et tardus).
How do you discern the difference between murmurs of valvular aortic stenosis and hypertrophic obstructive cardiomyopathy?
The systolic murmur of hypertrophic obstructive cardiomyopathy is increased with the Valsalva maneuver, whereas the murmur of aortic stenosis decreases with this maneuver.