If the stenosis is very severe then heart failure in infancy may occur. Usually the condition is asymptomatic but occasionally the child may present with faintness or dizziness on exertion.
The child appears well and is usually pink. Pulses are usually plateau pulses and of small volume. There may be a low systolic blood pressure.
On palpation the left ventricle may be prominent and may cause a thrill that is palpable at the lower left sternal edge, in the suprasternal notch and in the neck over the carotid arteries.
In the majority of cases a heart murmur is detected on routine examination. This is a systolic ejection murmur heard at the apex and lower left sternal edge, which is conducted upwards into the neck. There is often an ejection click that is heard immediately before the murmur. There may be paradoxical splitting of the second heart sound with respiration in severe aortic stenosis.
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