There are usually no symptoms until aortic stenosis is moderately severe (when the aortic orifice is reduced to one-third of its normal size). At this stage, exercise-induced syncope, angina, and dyspnoea develop. When symptoms occur, prognosis is poor- on average, death occurs within 2-3 years if there has been no surgical intervention.
Signs
Pulse
The carotid pulse is of small volume and is slow-rising or plateau in nature.
Precordial Palpation
The apex beat is not usually displaced because hypertrophy (as opposed to dilatation) does not produce noticeable cardiomegaly. However, the pulsation is sustained and obvious. A double impulse is sometimes felt because the fourth heart s
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Auscultation
The most obvious auscultatory finding in aortic stenosis is an ejection systolic murmur that is usually 'diamond-shaped' (crescendo-descendo)
the murmue is usually rough in quality and best head in the aortic area. it radiates into the carotid arteries and also the pericardium. the intensity of the murmur is not a good guide to the severity of the condition because it lessened by reduced carotid output. in severe cases, the murmur may be inaudible.
other findings include:
systolic ejection click unless the valve has become immobile and calcified
soft or inaudible artic second heart sound when the aortic valve becomes inaudible
reversed splitting of the second heart sound (splitting on expiration)
prominent fourth heart sound unless coexisitng mitral stenosis prevents this.
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