HISTORY. A history of rheumatic fever suggests possible cardiac valvular malfunction; however, many patients who have had rheumatic fever do not remember having had the condition; the diagnosis therefore is usually based on symptoms. Given the potential genetic causes, a family history of AS can be significant.

PHYSICAL EXAMINATION. The classic symptoms of aortic stenosis are chest pain, fainting on exertion (syncope), and labored breathing on exertion due to heart failure. Inspection of the thoracic wall may reveal a thrusting apical pulsation. A systolic thrill (vibrations felt from turbulent blood flow) may be palpated over the second intercostal space to the right of the sternum. A lift or heave may be palpated over the apex of the heart.

Auscultation of heart sounds reveals a harsh systolic crescendo-decrescendo murmur. The murmur, referred to as diamond-shaped, is considered the hallmark of AS. Auscultation of breath sounds may reveal fine crackles (rales) if pulmonary congestion is present in left-sided heart failure. The pulmonary congestion will vary with the amount of exertion and severity of stenosis.

PSYCHOSOCIAL. Because the symptoms of AS are usually gradual, most people have already made adjustments in their lifestyle to adapt and do not seek treatment until the symptoms become debilitating. Assess what the patient has already done to cope with this condition. In addition, assess the patient's degree of anxiety about a diagnosed heart condition and potential treatment.

Diagnostic Highlights


Normal Result

Abnormality with Condition


Cardiac catheterization

Normal aortic

Opening in the aortic

Aortic valve is narrowed with the

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