Aortic stenosis: examination findings and clinical course
THE CONTEXT
Clinical examination can suggest aortic stenosis, but its severity may be difficult to judge, especially in older patients.
Auscultatory findings
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A harsh ejection systolic murmur radiates to the neck, with a soft second heart sound, particularly when the valves are calcific.
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The murmur may resemble a saw cutting wood. In older patients, it may have a musical quality resembling the mew of a seagull.
Examination pitfalls and associated lesions
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An older patient with a stiff, non-compliant arterial system may have an apparently normal carotid upstroke despite severe aortic stenosis.
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Mild stenosis can be difficult to distinguish from aortic sclerosis, in which the valve is thickened or calcified without obstruction.
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Examine for other valve lesions, particularly in rheumatic heart disease, where concomitant mitral valve disease is frequent.
Clinical course
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Patients may remain asymptomatic for many years but deteriorate rapidly after symptoms develop.
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Subsequent outcomes can include cardiac failure, syncope and sudden death. This course contrasts with the usually very slow progression of mitral stenosis.