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.
  • 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’
  • 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