A 68-year old man who has had a recent syncopal Episode is hospitalized with congestive hea failure failure. His blood pressure is 160/80 mm Hg. His pulse rate is 80 Beats minute,and there is agrade lll/lV harsh systolic murmur.
Carotid upstroke. A delayed upstroke (pulsus parvus et tardus) can suggest aoic stenosis, left ventricular outflow obstruction, or significant decrease in stroke volume. Vascular stiffness due to aging can reduce the delay, causing a more normal-feeling upstroke Ref Davidson 23rd edition pg 456
Radiation of the murmur to die neck.
Decrease of me murmur with handgrip
Delayed carotid upstroke
Reduced left ventricular ejection fraction
C.V.S