Aortic valve thickening (sclerosis) without stenosis is common in elderly adults . It is often detected either as a systolic murmur on physical examination or on echocardiography performed for some other reason. Aortic valve sclerosis is important clinically because it can progress to aortic stenosis and is a marker for increased cardiovascular risk.
This topic will discuss the pathogenesis of aortic sclerosis and calcific aortic stenosis and the diagnosis, prevalence, clinical significance, and management of aortic sclerosis. The natural history, diagnosis, and management of aortic stenosis are discussed separately. (See "Natural history, epidemiology, and prognosis of aortic stenosis" and "Clinical features, diagnosis, and evaluation of aortic stenosis in adults" and "Medical management of symptomatic aortic stenosis" and "Medical management of asymptomatic aortic stenosis in adults" and "Indications for valve replacement in aortic stenosis in adults".)
Aortic sclerosis is an asymptomatic condition that is generally detected either as a systolic ejection murmur on physical examination or as an incidental finding on echocardiography.
Aortic sclerosis, in the absence of stenosis, may be associated with a midsystolic ejection murmur, which is usually best heard over the right second interspace. In general, the murmur is brief and not very loud. A normal carotid pulse and normal S2 suggest the absence of aortic stenosis (figure 1). (See "Auscultation of cardiac murmurs".)
However, many patients with aortic sclerosis have no murmur on physical examination. In such patients, the diagnosis is usually made incidentally on echocardiography performed for other indications.