Clinical, ECG and CXR Findings Associated With AS

Table 1 gives a breakdown of the clinical, ECG and CXR findings associated with AS:

Clinical, ECG and CXR findings associated with AS
Pulse	Slow rising small volume with a sustained peak (pulsus parvus et tardus). Often absent in the elderly due to loss of aortic compliance
Cardiac impulse	Sustained heaving apical impulse with a precordial thrill. Laterally displaced apex beat indicates onset of heart failure.
Auscultation	Harsh systolic ejection murmur second intercostal space left sternal edge and radiating to the carotids The murmur softens and becomes prolonged as the severity of AS increases Single second heart sound (S2) in moderate AS Paradoxical splitting of S2 or soft/obscured by murmur in severe AS Fourth heart sound ‘gallop rhythm’
ECG	LVH criteria (or strain pattern) but may be absent despite severe obstruction: 10-15% of severe AS have normal ECGs May show RBBB or LBBB AF usually in association with simultaneous mitral valve disease.
CXR	Seldom helpful. May show normal sized heart and a dilated proximal ascending aorta. Late signs are of LV/LA dilatation and pulmonary oedema. Calcium in the aortic valve of a patient <45 is indicative of AS