What are the clinical examination findings Aortic Stenosis (AS)

Clinical examination reveal the following signs in AS.

1.    Anacrotic pulse.

2.    Low  pulse pressure.

3.    Normal or raised JVP.

4.    Heaving apex-beat.

5.    Basal systolic thrill.

6.    Left parasternal heave if pulmonary artery hypertension is present.

7.    Loud P₂ if PAH+.

8.    Paradoxical splitting of S2.

9.    LVS_4.

10. Ejection click at apex.

11. Low pitched rough crescendo – descresendo ejection systolic murmur at the aortic area / apex that is conducted to the carotids.

So the signs are

1.    Anacrotic pulse.

2.    Heaving apex.

3.    Systolic thrill at the 2^nd right intercostal space.

4.    Soft A2 with paradoxic split.

5.    Aortic ejection click.

6.    Ejection systolic murmur.

What is the blood pressure in aortic stenosis

Low pulse pressure is seen in AS.

If the systolic BP > 200mmHg - It exclude severe AS.

If the systolic BP >140mm/Hg - There will be coexistent aortic regurgitation or hypertension. 

What is the JVP in AS

          JVP is usually normal in AS.

Prominent a wave may occur due to - Bern Hein effect.

Bernhein effect

          In aortic stenosis there is hypertrophy of interventricular septum which bulge into right ventricle producing prominent a wave in JVP.

What are the palpating finding in AS

1.    Hearing apex.

2.    Palpable S4.

3.    Systolic thrill in 2^nd RICS.

Comment on the apex beat in AS

Usually heaving apex is seen in AS. There is no displacement. Displaced apex beat may be there in AS due to coexisting aortic or mitral regurgitation and in let ventricular dysfunction.