Aortic Stenosis: Diagnosis

The diagnosis of aortic stenosis (AS) is reached through clinical and instrumental assessment of patients. The symptomatic forms are characterized by angina, dyspnea, and syncope, but the diagnostic suspicion can be supported by the presence of typical physical signs, such as harsh diamond-shaped systolic murmur, often matched by a more intense fremitus along the right upper sternal margin and irradiated to the neck, parvus et tardus pulse, fourth sound, and attenuation or disappearance of the aortic component of the second sound. A complete picture of heart failure can be found where a systolic murmur is often faint or lacking. In asymptomatic forms, physical findings can be the only evidence of aortic valve (AV) disease. With regard to instrumental examinations, standard electrocardiogram (ECG) can highlight signs of left ventricular hypertrophy. However, even in the more severe forms of AS, ECG may not show any alteration.