Aortic stenosis is notoriously difficult to diagnose during life in the absence of classical findings. Characteristically, a harsh systolic murmur is audible in the second interspace to the right of the sternum, in which a systolic thrill is palpable.1 The murmur is transmitted upward into the vessels of the neck. The second aortic sound is faint or absent. The blood pressure is low, and the heart rate is slow. The radial pulse rate is low and slow in rising.
Classical findings are frequently absent. There may be associated hypertension that changes the character of the pulse and of the second aortic sound; this can also occur with the accentuated second pulmonic sound present in failure of the left side of the heart or in mitral stenosis. The murmur may not be intense enough either to give rise to a thrill or to be transmitted upward. On the other hand,
Soloff LA, Zatuchni J, Turner L. AORTIC STENOSIS MANIFESTED AS CHRONIC COR PULMONALE. JAMA. 1952;150(11):1111–1113. doi:10.1001/jama.1952.63680110009013d
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