Clinical features of aortic stenosis

Symptoms include:

• often asymptomatic
• angina, syncope, exertional dyspnoea, dizziness, sudden death

Signs include:

• pulse: slow rising, small volume, narrow pulse pressure - plateau pulse
• blood pressure is normal.
• apex beat is heaving, undisplaced. There may be a systolic thrill, best felt with the patient sitting forward at the end of expiration
• heart sounds
  • second heart sound is normally split in mild aortic stenosis, P2 preceding A2. As stenosis increases in severity then reversed splitting occurs i.e. A2 preceding P2. If there is calcification of the aortic valve then A2 will become softer and may be inaudible all together.
  • fourth heart sound (S4) may be present.
  • ejection systolic murmur heart loudest in the aortic area which radiates to the apex and the carotids.
  • other sounds: ejection click if the valve is pliable. An ejection click excludes supra- or subaortic stenosis.

Note that the murmur of aortic sclerosis is identical, but is distinguished from aortic stenosis by the presence of a normal radial pulse wave and the absence of a thrill.