Clinical and special investigation features of aortic stenosis Aortic stenosis History Exertional dyspnoea Angina Syncope Physical findings Small-volume, slow-rising pulses Narrow pulse pressure JVP normal, unless heart failure or MV disease Pressure-loaded undisplaced apex beat Soft or single second heart sound Crescendo-decrescendo ejection systolic murmur at base of the heart Radiated to carotids Longer murmur = more severe High-pitched widely radiating murmur:
Gallavardin effect--can be mistaken for MR Systolic click in bicuspid valve may be heard Special investigations ECG Left ventricular hypertrophy CXR Normal-sized heart (ventricle) Aortic calcification Post-stenotic dilatation: especially in bicuspid valves Table 4.