Physical Findings that change Likelihood of Aortic Stenosis

Aortic stenosis (AS) is classically a mid-systolic crescendo-decrescendo murmur that radiates to the carotid.

Features that INCREASE likelihood [1]:

• Pulsus tardus (late) et parvus (weak) [slow rate of increase of the carotid pulse]
• Peak murmur intensity is late in systole
• Diminished S2 intensity or absence of S2
• Apical-carotid delay or Brachio-radial delay
• Maximal murmur sound at second right intercostal space

Features that DECREASE likelihood:

• Absence of a murmur radiating to the right clavicle (likelihood ratio [LR] 0.10; 95% confidence interval [CI] 0.01, 0.44) [2]

REFERENCES

1. Etchells E, Bell C, Robb K. Does this patient have an abnormal systolic murmur? JAMA. 1997 Feb 19;277(7):564-71.
2. Etchells E, Glenns V, Shadowitz S, Bell C, Siu S. A Bedside Clinical Prediction Rule for Detecting Moderate or Severe Aortic Stenosis. Journal of General Internal Medicine. 1998;13(10):699-704. doi:10.1046/j.1525-1497.1998.00207.