Which are the clinical findings of significant aortic stenosis? How can you estimate the degree of severity?
- Cresendo-decresendo systolic murmur with left ventricular hypertrophy
- Right mid-clavicular amplification
Radiates along the sash which passed anteriorly from right mid-clavicular area down over aortic valve area, further down to the apex, and to the 5th and 6th ICS in the anterior and mid-axillary lines, but not into the axilla.
- Severe cases cause paradoxical splitting
- Carotid shudder (in patients with severe aortic stenosis and severe aortic insufficiency)
- Parvus-et-tardus carotid upstroke
- Handgrip which increase the murmur exclude AS
- Murmurs tend to increase after a long diastole or amyl nitrite
- Degree of severity can be estimated by
- Late peaking of murmur
- Diminished or absent S2
- Estimating the interval between the peak PMI (felt with the right hand) and the peak of the carotid artery upstroke (felt with the left hand). These are separated in proportion to the severity of the stenosis.