GIM Question 18 Instructor

What symptoms may a patient with symptomatic aortic stenosis complain of on history?

A patient with symptomatic aortic stenosis may present with dyspnea on exertion, decreased exercise tolerance, angina with activity, and presyncope/syncope with activity.

What features would you look for on clinical exam to help determine the severity of aortic stenosis?

Features on physical exam for severe aortic stenosis may include:

  • Grade ≥3/6 late-peaking systolic murmur with radiation to the carotids
  • Paradoxically split S2 sound
  • Delayed carotid upstroke
  • Delayed brachial-radial pulse

These features on physical exam are specific but not sensitive to aortic stenosis. A normal S2 may be present in aortic stenosis, but not in hemodynamically significant aortic stenosis.

Aortic sclerosis can be clinically differentiated from aortic stenosis by the presence of a midsystolic ejection murmur, a normal carotid pulse and a normal S2.

Nishimura RA et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014, 63:e57-185.

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