Sandbox MC

Disease	History	Symptoms	Physical examination	Cardiac murmur	ECG	CXR	Echocardiography
Aortic valve stenosis		Exertional chest pain Dyspnea on exertion Decreased exercise tolerance Exertional syncope/pre-syncope	Narrow pulse pressure Normal to anacrotic carotid pulse (parvus et tardus) S1 usually normal A systolic ejection click may be audible afer S1 Single S2 If severe: paradoxical splitting of S2 S4 may be audible	Mid-to-late peaking systolic ejection murmur Best heard at right intercostal space Radiates equally to the carotid arteries Decseases with Valsalva maneuver	Left ventricular hypertrophy Left ventricular strain pattern	Left ventricualar hypertrophy If heart failure is present: pulmonary congestion Aortic valve calcification may be visible	Mild AS: Aortic Vmax 2.0-2.9 m/s or mean ΔP <20 mmHg Moderate AS: Aortic Vmax 3.0-3.9 m/s or mean ΔP 20-39 mmHg Severe AS: Aortic Vmax ≥ 4 m/s or mean ΔP ≥40 mmHg; AVA typically ≤ 1.0 cm2 (or AVAi ≤ 0.6 cm2/m2) Very severe AS: Aortic Vmax ≥ 5 m/s or mean ΔP ≥60 mmHg Ejection fraction (EF) may be normal or reduced
Aortic valve sclerosis without stenosis
Supvalvular stenosis
Supravalvular stenosis
Hypertrophic obstructive cardiomyopathy