Aortic Stenosis

At physical exam rounds, we discussed aortic stenosis.

Some key points:

Possible findings:

Vitals- Narrow pulse pressure

Pulses- Carotid may have low volume (parvus) and slow rate of rise (tardus). Brachio-radial delay, apical-carotid delay

JVP- Elevated if R heart failure as consequence of pulmonary edema (late)

Precordial palpation- Displaced, sustained apex, palpable S4, thrill

Heart sounds- Diminished S2, paradoxically split S2, S4

Murmur- Mid to late- peaking crescendo-decrescendo systolic murmur loudest in aortic area radiating to R clavicle, R carotid, or apex (Gallavardin)


Findings shown to rule out or rule in AoS

Sensitive (used to rule out)

Any systolic murmur

Murmur radiation to R clavicle (JGIM) or R carotid (JAMA) - see references


Specific (used to rule in)

Pulsus parvus et tardus (JAMA and JGIM)

Decreased intensity of S2 (JAMA and JGIM)

Mid to late-peaking systolic murmur (JAMA and JGIM)

Brachio-radial delay (JAMA)

Apical-carotid delay (JAMA)












Flow diagram from Etchells et al


References:

Click here for JGIM bedside clinical prediction rule

Click here for JAMA article on abnormal systolic murmur