signs of aortic stenosis

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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

Last reviewed 01/2018