Aortic Stenosis:

Please examine the Cardiovascular System of this 74 year old gentleman who
presents with chest pain on exertion.

Clinical Examination:

Classical Signs Additional Signs

- Low volume, slow rising pulse - Markers of severity:

- Ejection systolic murmur heard o Decreased pulse pressure
loudest in the aortic region o soft second heart sound,
- Murmur radiates to the carotids o systolic heave/thrill over
- Heaving, undisplaced apex beat aortic area,
o signs of heart failure
- Features of infective
endocarditis
- S4 may be heard
Common Discussion Topics:
Diagnosis and differentials for an ejection systolic murmur
Causes of aortic stenosis
Symptoms/Complications and Markers of severity
Investigations
Management

Quick Revision:
Differentials for ESM: Pulmonary stenosis, Hypertrophic obstructive
cardiomyopathy, Mitral regurgitation, Ventricular septal defect, Aortic sclerosis

Investigations Complications

ECG – LVH Observe the patient if asymptomatic and

CXR – calcification of aortic valve,
cardiac enlargement
Echo:
Mild stenosis valve area > 1.5cm²
Moderate stenosis valve area 1.0 – 1.5
cm²
Severe stenosis valve area ≤ 1.0cm²
valvular gradient ‹50mmHg
Consider surgical treatment if patient is
symptomatic or if asymptomatic with a
valvular gradient > 50mmHg with one of:
a valvular area of 0.6cm²;
ventricular tachycardia or abnormal
response to exercise