Severity of Stenosis:

•Normal aortic valve area 2.5-3.5 cm2

•Mild stenosis 1.5-2.5 cm2

•Moderate stenosis 1.0-1.5 cm2

•Severe stenosis < 1.0 cm2

•Critical stenosis < 0.7 cm2

•Onset of symptoms

~0.9 cm2 with CAD

~0.7 cm2 without CAD

Symptoms:

•Cardinal Symptoms:

–Chest pain (angina).

•Reduced coronary flow reserve.

•Increased demand-high afterload:

–Syncope/Dizziness (exertional pre-syncope).

•Fixed cardiac output.

•Vasodepressor response:

–Dyspnea on exertion & rest;

–Impaired exercise tolerance.

•Other signs of LV failure.

–Diastolic & systolic dysfunction.

Inspection, palpation, percussion:

1)pallor of the skin and mucous membranes

2)lifting apical impulse,

shifted down and to the left, spilled, high, resistant

3) systolic tremor in the I m / p to the right of sternum and behind the breastbone ("cat purr")

Auscultation of the heart:

1)Weakening 1 tone at the top:

2)1 tone weakens or disappears due to wrinkling of the aortic valve cusps.

3)Diastolic murmur, in the aorta, including Botkin and

even, sluggish, at the top, due

a backward wave of blood from the aorta to the LV. Noise

occurs immediately after the I tone, gradually decreases in intensity towards the end diastole., differs in soft blowing

character.

EKG:

1. LVH.

Echocardiography:

Etiology

Valve gradient and areaLVH

Systolic LV functionDiastolic LV functionLA size

Concomitant regional wall motion abnormalitiesCoarctation associated with bicuspid AV

Doppler estimation of AVA:

X-ray diagnostics:

1.LV hypertrophy.

2.Aortic configuration of the heart.

3.Deviation of the esophagus along a large radius.