Saturday, July 18, 2009

Physical Exam - Aortic Stenosis

To determine if a systolic murmur is related to aortic stenosis, consider the following predictive factors:

The following factors are SENSITIVE (help to rule OUT aortic stenosis)
No systolic murmur
No radiation of murmur to right clavicle

The following are SPECIFIC (help to rule IN aortic stenosis)
Pulsus parvus
Plusus tardus
Decreased S2
Brachioradial delay
Apical carotid delay
Mid-late peaking murmur

Two very good evidence based evaluations supporting this are the JAMA Rational Clinical Exam Series paper on systolic murmurs and the JGIM paper on aortic stenosis. Both come from Toronto clinicians, and are linked here and here.

1 comment:

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