CC: SOB
Examine the heart
Diagnosis :
Aortic Stenosis
Clinical signs:
Ejection systolic murmur , heard on right side and radiate to carotid
Apex beat sustained ( heaving )
Thrill, in right second intercostal space
Carotid pulse is delayed & diminished ( parvus et tardus )
Differential diagnosis :
HOCM
VSD
Aortic sclerosis
Murmurs of pregnancy and anemia
Causes:
Congenital ( bicuspid )
Rheumatic
Calcification
Symptoms of aortic stenosis:
1. Angina
2. syncope
3. SOB
Severity of AS:
soft or absent aortic component of second heart sound
Delayed ESM
S4
Investigation:
ECG: LVH
Echo: severe aortic stenosis ( area less 1cm & mean gradient more 40 mmhg )
C. Angio
Management:
Asymptomatic
No specific treatment
Regular follow up with echo & good dental hygiene
Surgery
Symptomatic
