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Original Investigation
December 1982

Clinical Clue of Severe Aortic Stenosis: Simultaneous Palpation of the Carotid and Apical Impulses

Author Affiliations

From the Cardiology Service, Walter Reed Army Medical Center, Washington, DC. Dr Chun is now with the Tripler Army Medical Center, Tripler AMC, Hawaii.

Arch Intern Med. 1982;142(13):2284-2288. doi:10.1001/archinte.142.13.2284

• In patients with severe aortic stenosis, simultaneous palpation of the carotid and apical impulses yields a palpable lag time between the two. Apexcardiograms and carotid pulse tracings were recorded in 66 control subjects and in 30 patients with aortic stenosis. Using the QRS peak as reference, the peak appearance time of the carotid pulse tracings and apexcardiograms was measured, and the difference was calculated as a palpable lag time; 21/30 patients had a palpable lag time, whereas nine did not; 22/30 patients with aortic stenosis had aortic valve areas of less than 1 sq cm. Twenty-one of these 22 patients had a palpable lag time. The sensitivity of a palpable lag time for aortic valve areas of less than 1 sq cm was 95%, specificity 100%, positive predictive value 100%, and negative predictive value 89%. The group means for measured lag times between controls (70 ± 7 ms) and those patients with aortic stenosis (133 ± 7 ms) showed a definite difference. The palpable lag time by linear regression analysis had an r of .68, third in rank to the aortic valve gradient and ECG for predicting aortic valve area. Multiple regression analysis found the palpable lag time, ECG, syncope, and shudder waves together able to predict the aortic valve area (r = .85).