Page 125 - Clinical Pearls in Cardiology

Valvular Heart Diseases 113

develop. Death usually ensues within 3–5 years of the
onset of symptoms. So all patients with asymptomatic
aortic stenosis should be kept under periodic review,
as the development of symptoms is an indication for
prompt valve replacement surgery. (Note: Average
survival is 3 years after the development of angina and
1.5 years after the development of dyspnea in untreated
cases).
20. What are the clinical features of severe aortic stenosis?
The clinical signs indicating severity of aortic stenosis
are the following:
• Narrow pulse pressure (average SBP is 100 mmHg;
average DBP is 70 mm Hg)
• Slow or delayed upstroke of carotid pulse
• Brachioradial delay—radial pulse is delayed relative
to the brachial pulse
• Short interval between S1 and ejection click
• Single S2 with absent or soft A2
• Paradoxical splitting of S2 (i.e. A2 follows P2)
• Presence of S4
• Long, loud, harsh, rasping mid-systolic crescendo-
decrescendo murmur with late peaking in the aortic
area.
21. What are the clinical features of aortic valve sclerosis?
Degenerative calcific aortic valve disease without a
significant gradient or outflow obstruction is called as
aortic sclerosis. Aortic sclerosis is the initial stage of
calcific degeneration of aortic valve and, even in the
absence of valve obstruction, is associated with a 50%
increased risk of cardiovascular death and myocardial
infarction. It is the most common cause of systolic
murmur in the elderly population (sometimes referred