Exercise Testing in Patients with Aortic Stenosis: Physical Examination
Blood pressure was 150/90 mm Hg, regular pulse rate of 86, and respirations 16. He was a well developed, well nourished elderly white male. HEENT was normal, and the neck was supple without adenopathy Jugular venous pulse was non-distended with normal a and v waves. Carotids were slightly decreased in amplitude and had a slightly reduced upstroke velocity. No thrills were present, but there was a transmitted murmur from the base of the heart Lungs were clear to auscultation and percussion. The apical impulse was sustained but not displaced. A normal Sb soft S2, and A2, normal splitting of S2, no S4, no S3, and a grade 2/6 systolic ejection murmur with mid peaking at the right upper sternal border radiating to the neck were heard.
A diastolic murmur was not appreciated. The abdomen was normal. Extremities and peripheral pulses were normal. Electrocardiogram revealed normal sinus rhythm, left atrial abnormality and voltage criteria for left ventricular hypertrophy Chest x-ray film revealed an enlarged ascending aorta and left ventricular enlargement Lateral chest x-ray examination revealed evidence of calcification of the aortic valve and left ventricular enlargement Echocardiogram was technically inadequate. Aortic valve calcification was present, but valve leaflet excursion and left ventricular wall thickness could not be assessed. Doppler echocardiography was not performed. canadian pharmacy
At cardiac catheterization, a 52 mm Hg mean aortic valve gradient and valve area of 0.8 cm were found. His left ventricular end-diastolic pressure was 17 mm Hg, but all other hemodynamic values were normal. His coronary arteries had mild irregularities, but no significant stenoses, and his ejection fraction was normal at 60 percent He had no aortic valve regurgitation. Following catheterization, the patient underwent aortic valvular replacement and was asymptomatic at follow up.