What is the sign in physical exam with which we can say aortic stenosis in a case is not severe?

Question

I mean only by physical exam, it tells us that AS is not severe?

Answer 1

Some people believe in a sign called "apico-carotid delay":

Found in "Clinical clue of severe aortic stenosis. Simultaneous palpation of the carotid and apical impulses."

http://www.ncbi.nlm.nih.gov/pubmed/62168...

In another paper, finding 3 or 4 of the following on physical exam predicts moderate to severe aortic stenosis:

- slow carotid artery upstroke

- reduced carotid artery volume

- maximal murmur intensity at the second right intercostal space

- reduced intensity of the second heart sound

http://www.pubmedcentral.nih.gov/article...

Of course, if you are a believer of the JAMA Rational Clinical Exam series, you'll answer "the most useful finding for ruling out aortic stenosis is the absence of murmur radiation to the right carotid artery (negative likelihood ratio, 0.05-0.10)".

http://jama.ama-assn.org/cgi/content/abs...

Finally, if you ask the hospital lawyer, he/she will tell you to get an echo....