Signs of aortic stenosis

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