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Signs of aortic stenosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The patient is usually well unless suffering from infective endocarditis or heart failure.

The clinical signs of aortic stenosis are classified as shown:

  • pulse:
    • rhythm:
      • usually in sinus rhythm
      • atrial fibrillation suggests rheumatic aetiology with co-existing mitral stenosis
    • amplitude - this is reduced
  • wave form - slow upstroke (plateau pulse)

  • jugular venous pressure - this is often normal unless right ventricular failure has developed due to pulmonary hypertension resulting from left ventricular failure

  • cardiac impulses - left ventricular hypertrophy can often be detected (impulse prominent if the patient is inclined to the left)

  • auscultation
    • ejection murmur:
      • loud in the aortic area, at the apex and in the neck
      • in an elderly patient this may be maximal at the apex
    • ejection click:
    • usually loudest at the apex
      • if severe valve calcification then will be absent
      • an ejection click excludes supra- or subaortic stenosis

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