clinical features

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Possible symptoms include:

  • angina
  • dyspnoea
  • palpitations
  • syncope
  • sudden death

Clinical signs include:

  • jerky pulse
  • JVP: large a waves, indicating right ventricular flow obstruction
  • double impulse at apex
  • loud fourth heart sound due to the left ventricular hypertrophy
  • third heart sound
  • late systolic murmur:
    • this is a result of outflow tract obstruction with or without mitral regurgitation
    • the murmur is late in systole because some blood must be ejected from the ventricle before the outflow is obstructed
    • the murmur is louder during a Valsalva manoeuvre
    • the murmur is softer when squatting

Last reviewed 01/2018