The onset of symptoms indicates a worse prognosis and is associated with approximately 50% mortality at 2 years. The cardinal symptoms of severe aortic stenosis are all typically provoked by exertion.
The majority of patients with aortic stenosis are asymptomatic. The red flags to consider when taking a patient history should include:
Dr Martin Ng states “If an elderly patient presents with shortness of breath, hear them out and put a stethoscope on their chest and see if they have a heart murmur. That could be the first step for them to get treatment.”
Important! Ask relatives if they have noticed any changes to the patient’s physical activity levels.
Asking specific questions about functional capacity may help to identify if there has been a significant deterioration over a prolonged period.
The character of the pulse tends to be of low volume, reflecting the reduction in flow across the narrowed valve, which is most prominent in the carotid region where the pressure on the palpating finger slowly rises to maximum amplitude (slow rising pulse).
Low volume, slow rising
Systolic murmur (crescendo-decrescendo)