In severe aoic stenosis true finding is :
Answer is C (ST segment changes in ECG) `ST and T wave changes on ECG our severe aoic stenosis' -- Ghai Thus ST segment changes in ECG is the answer of choice. Ejection click is not used to assess the severity of stenosis. The later having the peak of ejection systolic murmur, the more severe is the stenosis. Cardiac size usually remains normal and so the apex though is not shifted outwards usually. S2 does not show much variation in intensity. With increasing severity the S2 follows the following order normal split --> single --> paradoxical split The clinical assessment of severity of aoic stenosis depends on the following: Ghai 6th/ 418 Presence of Symptoms : Symptomatic patients have severe Aoic stenosis however if the patient is asymptomatic it does not rule out severe Aoic stenosis. Pulse pressure : Narrower the pulse pressure, the more sever the stenosis Systolic thrill Only in the suprasternal Systolic thrill at the Disappearance of an earlier notch not at the second Rt. second Rt. interspace existent thrill interspace Mild or critical aoic stenosis Severe aoic stenosis Very severe aoic stenosis Peak of the ejection systolic murm ur :The later the peak of the ejection systolic murmur, the more severe is the stenosis S,Split Normal split Closely split/ Normal/ Single Paradoxical split Mild Moderate Severe Presence of S4 Presence of S3 indicates severe aoic stenosis with congestive cardiac failure. ECG changes : ST & T wave changes in ECG X Ray chest: Cardiac enlargement Doppler echo: Quantitative gradient
Late systolic ejection click.
Heaving with outward apex
ST segment changes in ECG
Loud S2