Page 137 - Clinical Pearls in Cardiology

Valvular Heart Diseases 125

35. What are the clinical features of aortic stenosis?
Table 7: Clinical features of aortic stenosis
History • Angina chest pain, exertional syncope, dyspnea
• Slow rising pulse with reduced amplitude and
Pulse sustained contour, with or without carotid thrill
(anacrotic or pulsus parvus et tardus)
Precordial • Usually undisplaced and heaving apical
impulses impulse
• S1 is normal
• Absent S2 or soft S2 with paradoxical splitting
• S4 and S3 in late stages with left ventricular
Heart sounds dysfunction
• Ejection click (high-pitched systolic sound
which helps to localize the pathology to the
valvular level; best heard at the cardiac apex)
• High-pitched, harsh or rasping, late peaking,
mid-systolic murmur in the aortic area,
radiating to the carotids. The murmur is
Murmur
preceded by ejection click
• Presence of Gallavardin effect (especially in
elderly)

Note: The murmur of aortic stenosis is best heard with the diaphragm
of the stethoscope in the sitting up and leaning forward position, with
the breath held in expiration