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How will you assess the severity of aortic stenosis

Clinical features that help in assessing the severity of aortic stenosis are
1.    Pulse
2.    Split of S2
3.    S4
4.    Length of murmur
5.    Peaking of murmur
6.    Loudness of murmur
7.    Thrill
Severity is based on
1.    Splitting of S2
Mild AS         - A2is followed by P2
Moderate AS - A2 is delayed resulting in single S2
Severe AS    - P2 - A2 reverse splitting of S2
2.    Presence of S4 and absent A2
3.    Presence of S3
4.    Long murmur and late peaking of murmur
5.    According to valve surface area
6.    According to gradient across the valve
Mild AS
Moderate AS
1.    Anacrotic pulse
2.    Thrill
3.    Long murmur
4.    Loud murmur
5.    Late peaking
1.    Anacrotic pulse
2.    Thrill
3.    Long murmur
4.    Late peaking
5.    Loud murmur
6.    Paradoxic split
7.    LVS­4
Severity based on valve area
1.    Normal valve area   : 2.5 – 3.5cm2
2.    Tight (critical AS )   : <0.5cm2 / m2 body surface are -0.8cm.
Severity of AS based on hemodynamic gradient
It is based on gradient across the valve
1.    Mild AS         : 25-50mm Hg
2.    Moderate AS : 50-75mmHg
3.    Severe AS     : >75mm/Hg
Severity of aortic stenosis is assessed with
1.    Low volume slow raising pulse
2.    Systolic decapitation of blood pressure
3.    Paradoxical splitting of S2
4.    Presence of S4